warfarin and Hypertrophy--Left-Ventricular

Topics: Anticoagulants; Atrial Fibrillation; Factor Xa Inhibitors; Humans; Hypertrophy, Left Ventricular; Prospective Studies; Pyrazoles; Pyridones; Risk Assessment; Risk Factors; Stroke; Thromboembolism; Time Factors; Treatment Outcome; Ventricular Function, Left; Ventricular Remodeling; Warfarin

We tested the hypothesis that left ventricular hypertrophy (LVH) interferes with the antithrombotic effects of dabigatran and warfarin in patients with atrial fibrillation (AF).. This is a post-hoc analysis of the Randomized Evaluation of Long-term anticoagulation therapY (RE-LY) Study. We defined LVH by electrocardiography (ECG) and included patients with AF on the ECG tracing at entry. Hazard ratios (HR) for each dabigatran dose vs. warfarin were calculated in relation to LVH. LVH was present in 2353 (22.7%) out of 10 372 patients. In patients without LVH, the rates of primary outcome were 1.59%/year with warfarin, 1.60% with dabigatran 110 mg (HR vs. warfarin 1.01, 95% confidence interval (CI) 0.75-1.36) and 1.08% with dabigatran 150 mg (HR vs. warfarin 0.68, 95% CI 0.49-0.95). In patients with LVH, the rates of primary outcome were 3.21%/year with warfarin, 1.69% with dabigatran 110 mg (HR vs. warfarin 0.52, 95% CI 0.32-0.84) and 1.55% with 150 mg (HR vs. warfarin 0.48, 95% CI 0.29-0.78). The interaction between LVH status and dabigatran 110 mg vs. warfarin was significant for the primary outcome (P = 0.021) and stroke (P = 0.016). LVH was associated with a higher event rate with warfarin, not with dabigatran. In the warfarin group, the time in therapeutic range was significantly lower in the presence than in the absence of LVH.. LVH was associated with a lower antithrombotic efficacy of warfarin, but not of dabigatran, in patients with AF. Consequently, the relative benefit of the lower dose of dabigatran compared to warfarin was enhanced in patients with LVH. The higher dose of dabigatran was superior to warfarin regardless of LVH status.. http:www.clinicaltrials.gov. Unique identifier: NCT00262600.

Topics: Aged; Aged, 80 and over; Anticoagulants; Antithrombins; Atrial Fibrillation; Dabigatran; Drug Administration Schedule; Electrocardiography; Female; Humans; Hypertrophy, Left Ventricular; Male; Middle Aged; Risk Factors; Stroke; Time Factors; Treatment Outcome; Ventricular Function, Left; Ventricular Remodeling; Warfarin

Some patients experience a left atrial thrombus (LAT) in spite of taking warfarin. We aimed to clarify the characteristics of patients with LAT during warfarin administration and investigated whether the CHADS2 or CHA2DS2-VASc scores are useful predictors of LAT. We studied 230 patients (169 males, age 65 ± 10 years) who underwent transesophageal echocardiography (TEE) prior to cardioversion or catheter ablation of atrial tachyarrhythmias between 2008 and 2012. All patients were taking oral warfarin. LAT was detected in 19 patients (8.3%) using TEE. LAT was significantly associated with the presence of hypertension (P = 0.0035), prior congestive heart failure (P < 0.0001), structural heart disease (P = 0.0012), persistent arrhythmias (P < 0.0001), the absence of SR during TEE (P = 0.0070), left ventricular ejection fraction (P < 0.0001), left atrial diameter (P = 0.0015), left ventricular dimension during end diastole (P = 0.0215), left ventricular hypertrophy (LVH; P < 0.0001), and the E/e' ratio (P = 0.0074). A multivariate analysis showed that LVH (P = 0.0065, OR 5.591, 95% CI 1.618–19.316) and persistent arrhythmia (P = 0.0364, OR 12.121, 95% CI 1.171–125.451) were independently associated with LAT. Moreover, the mean CHADS2 (2.3 ± 0.9 vs. 1.4 ± 1.2) and CHA2DS2-VASc scores (3.8 ± 1.2 vs. 2.8 ± 1.7) were higher in the patients with than without LAT. However, a multivariate analysis showed that the CHADS2/CHA2DS2-VASc scores did not associate with LAT. LVH and persistent arrhythmia may be useful for predicting LAT in patients with atrial tachyarrhythmias.

Topics: Administration, Oral; Aged; Anticoagulants; Chi-Square Distribution; Comorbidity; Decision Support Techniques; Echocardiography, Transesophageal; Female; Humans; Hypertrophy, Left Ventricular; Japan; Logistic Models; Male; Middle Aged; Multivariate Analysis; Odds Ratio; Predictive Value of Tests; Retrospective Studies; Risk Factors; Tachycardia, Supraventricular; Thrombosis; Treatment Outcome; Warfarin

Previous studies on the association between the distribution of left ventricle hypertrophy and the clinical features of hypertrophic cardiomyopathy (HCM) have yielded unclear results. The aim of this study was to investigate the differences in the prevalence, clinical features, management strategies, and long-term outcomes between patients with midventricular hypertrophic obstructive cardiomyopathy (MVHOCM) and patients with apical HCM (ApHCM).. A retrospective study of 60 patients with MVHOCM and 263 patients with ApHCM identified in a consecutive single-centre cohort consisting of 2068 patients with HCM was performed. The prevalence, clinical features, and natural history of the patients in these 2 groups were compared.. Compared with ApHCM patients, patients with MVHOCM tended to be much younger and more symptomatic during their initial evaluation. Over a mean follow-up of 7 years, the probability of cardiovascular mortality and that of morbidity was significantly greater in MVHOCM patients compared with ApHCM patients (log-rank, P < 0.001).. Our results suggest that, compared with ApHCM, MVHOCM represents an uncommon presentation of the clinical spectrum of HCM that is characterized by progressive clinical deterioration leading to increased cardiovascular mortality and morbidity. Our results also underscore the importance of the timely recognition of MVHOCM for the prediction of prognosis and the early consideration of appropriate management strategies.

Topics: Ablation Techniques; Adrenergic beta-Antagonists; Adult; Age Factors; Anticoagulants; Calcium Channel Blockers; Cardiomyopathy, Hypertrophic; Cohort Studies; Echocardiography; Echocardiography, Doppler, Color; Female; Follow-Up Studies; Heart Ventricles; Humans; Hypertrophy, Left Ventricular; Magnetic Resonance Imaging, Cine; Male; Middle Aged; Pacemaker, Artificial; Phenotype; Retrospective Studies; Syncope; Tachycardia, Ventricular; Thrombosis; Warfarin

Topics: Administration, Intravenous; Adult; Anticoagulants; Antihypertensive Agents; Diagnosis, Differential; Echocardiography; Embolism; Heparin; Humans; Hypertension, Malignant; Hypertrophy, Left Ventricular; Lateral Medullary Syndrome; Magnetic Resonance Angiography; Male; Medulla Oblongata; Vertebral Artery; Vertebral Artery Dissection; Warfarin

Isolated systolic hypertension results from a gradual stiffening of large arteries, to which medial elastocalcinosis (calcification of elastic lamellae) contributes. There is compelling evidence that reactive oxygen species (ROS) are associated with several disease processes affecting the cardiovascular system, including hypertension. The present study was designed to investigate whether the inhibition of ROS production by alpha-lipoic acid can prevent vascular calcification. Sprague-Dawley rats were treated with warfarin (20 mg/kg/day) and vitamin K (15 mg/kg/day) (WVK) for 4 weeks to induce large artery calcification. Subgroups received either a normal diet or a diet supplemented with lipoic acid (1000 mg/kg/day). The WVK treatment produced a small elevation of aortic superoxide levels that did not reach statistical significance. Alpha-lipoic acid reduced the elevation below baseline levels. In rats treated with alpha-lipoic acid, the WVK-induced elevation of pulse wave velocity (an index of arterial stiffness), left ventricular hypertrophy, and aortic, femoral and carotid elastocalcinosis were not prevented. Although a contribution of oxidative stress has been suggested in the aging cardiovascular system, this alteration does not appear to contribute to the calcification process and the subsequent stiffening of large arteries in the animal model tested.

Topics: Animals; Arteries; Calcinosis; Dietary Fats; Hypertrophy, Left Ventricular; Male; Oxidative Stress; Rats; Rats, Sprague-Dawley; Reactive Oxygen Species; Superoxides; Thioctic Acid; Vascular Diseases; Vitamin K; Warfarin