vitamin-k-semiquinone-radical and Ventricular-Dysfunction--Left

Left ventricular thrombi form due to the presence of Virchow's triad in patients with left ventricular systolic dysfunction. This complication increases the incidence of systemic embolization, hence anticoagulation is recommended to decrease this risk. Up to the present time, vitamin K antagonists are recommended by all societal guidelines for patients with left ventricular thrombi. Recently, several studies have investigated the role of different anticoagulants and yielded promising outcomes. This opinion article focuses on the evidence supporting vitamin K antagonists and direct oral anticoagulants in patients with left ventricular thrombi.

Topics: Administration, Oral; Anticoagulants; Atrial Fibrillation; Fibrinolytic Agents; Humans; Thrombosis; Ventricular Dysfunction, Left; Vitamin K

Microcirculatory changes contribute to clinical symptoms and disease progression in chronic heart failure (CHF). A depression of coronary flow reserve is associated with a lower myocardial capillary density in biopsies. We hypothesized that changes in cardiac microcirculation might also be reflected by a systemic reduction in capillaries and visualized by sublingual videomicroscopy. The aim was to study in vivo capillary density and glycocalyx dimensions in patients with CHF vs healthy controls.. Fifty patients with ischaemic and nonischaemic CHF and standard treatment were compared to 35 healthy age-matched subjects in a prospective cross-sectional study. Sublingual microcirculation was visualized using a sidestream darkfield videomicroscope. Functional and perfused total capillary densities were compared between patients and controls. A reduced glycocalyx thickness was measured by an increased perfused boundary region (PBR).. Median functional and total perfused capillary densities were 30% and 45% lower in patients with CHF (both P < .001). Intake of oral vitamin K antagonists was associated with significantly lower capillary densities (P < .05), but not independent of NT-proBNP. Dimensions of the glycocalyx were marginally lower in CHF patients than in healthy controls (<7% difference). However, PBR correlated significantly with inflammation markers (fibrinogen: r = .58; C-reactive protein: r = .42), platelet counts (r = .36) and inversely with measures of liver/renal function such as bilirubin (r = -.38) or estimated glomerular filtration rate (r = -.34) in CHF patients.. CHF patients have got a markedly lower functional and total perfused capillary density in sublingual microvasculature when compared to controls, indicating a systemic decrease in microcirculation.

Topics: Administration, Oral; Adult; Aged; Aged, 80 and over; Anticoagulants; Biomarkers; Capillaries; Chronic Disease; Cross-Sectional Studies; Female; Glomerular Filtration Rate; Glycocalyx; Heart Failure; Humans; Male; Microcirculation; Microscopy, Video; Microvascular Rarefaction; Microvessels; Middle Aged; Mouth Floor; Natriuretic Peptide, Brain; Peptide Fragments; Platelet Count; Prospective Studies; Stroke Volume; Ventricular Dysfunction, Left; Vitamin K

New oral anticoagulants (NOAC) have demonstrated their efficacy as an alternative to vitamin K antagonists (VKA) in the prophylaxis of cardioembolic events in patients with atrial fibrillation (AF). However, evidence on the benefits of NOAC in health-related quality of life (HRQoL) is lacking.We evaluated changes in HRQoL related to oral anticoagulation therapy employing a specific questionnaire in a cohort of 416 patients with AF undergoing electrical cardioversion. In terms of HRQoL, we observed a progressive adaptation to treatment with VKA; satisfaction with NOAC remained constant. Older age, higher left ventricular ejection fraction and NOAC were associated with better HRQoL.

Topics: Administration, Oral; Aged; Anticoagulants; Atrial Fibrillation; Benzimidazoles; beta-Alanine; Dabigatran; Humans; Male; Middle Aged; Quality of Life; Ventricular Dysfunction, Left; Vitamin K

Despite the high prevalence and clinical importance of atrial fibrillation (AF), there is no Brazilian study describing the clinical profile of patients with AF and the most used treatment strategy (rhythm control vs. rate control).. Assess the most common treatment on AF in an outpatient specialized clinic for management of AF. In addition, the clinical profile of the population studied was provided.. Cross-sectional study assessing the most used strategy for atrial fibrillation control in 167 patients. The clinical profile was also described. A standardized form was used for data collection and statistical analysis was performed by SPSS 13.0 software.. In This high risk population for thromboembolic events (61% had CHADS(2) ≥ 2), 54% of patients had paroxysmal or persistent AF, 96.6% were on vitamin K antagonists or acetylsalicylic acid, and 76.6% on beta-blocker (rate control 81,2% x rhythm control 58,8%; p < 0.05). Heart rate control was the most used strategy (79.5% x 20.5%; p < 0.001). A statistical tendency towards more patients with ventricular dysfunction (15.2% x 2.9%; p = 0.06), CHADS(2) ≥ 2 (60.5% x 39.5%; p = 0.07) and heart valve diseases (25.8% x 11.8%; p = 0.08) was observed in the heart rate control group.. In this high risk population for thromboembolic events, the rate control strategy was the most used.

Topics: Adrenergic beta-Antagonists; Aged; Ambulatory Care; Anti-Arrhythmia Agents; Aspirin; Atrial Fibrillation; Brazil; Epidemiologic Methods; Female; Heart Conduction System; Heart Rate; Heart Valve Diseases; Humans; Male; Thromboembolism; Ventricular Dysfunction, Left; Vitamin K

Atrial fibrillation, the most frequent arrhythmia, has a growing incidence with increasing age and the most important complication of the disease is thromboembolic events that may be prevented by antivitamin K. They are the most efficient therapeutic class for the prevention of these events but they are associated with an increased haemorrhagic risk leading to a reduced prescription in general practice. Optimisation of the management should be based on an individual evaluation of the thromboembolic and haemorrhagic risks, taking into account age, the presence of an associated heart disease, hypertension, diabetes, history of cerebrovascular event, history of previous haemorrhagic event and the ability to achieve a stable target INR. The challenge in ventricular arrhythmias lies in identifying a high risk of sudden death, mainly related to ventricular fibrillation. In patients with structural heart disease, left ventricular dysfunction is the strongest predictor of sudden death. Non invasive markers such as non sustained ventricular tachycardia, late ventricular potentials, decreased heart rate variability and baroreflex sensitivity, and repolarization altemans are further elements to assess risk. However, most of these markers have a poor positive predictive value and a low specificity. In patients with normal hearts, genetic predisposition may in the future identify high risk patients. The electrophysiologic study with programmed ventricular stimulation remains a costly and invasive method and only has a strong positive predictive value in ischemic cardiomyopathy. More precise algorithms for risk stratification are thus needed that may help the strategy of therapy with prophylactic implantable cardioverter defibrillator in the future.

Topics: 4-Hydroxycoumarins; Age Factors; Anticoagulants; Arrhythmias, Cardiac; Atrial Fibrillation; Baroreflex; Cardiac Pacing, Artificial; Death, Sudden, Cardiac; Diabetes Complications; Electrocardiography; Heart Diseases; Heart Rate; Hemorrhage; Humans; Hypertension; Indenes; International Normalized Ratio; Myocardial Ischemia; Risk Assessment; Risk Factors; Stroke; Tachycardia, Ventricular; Thromboembolism; Ventricular Dysfunction, Left; Ventricular Fibrillation; Vitamin K