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1. Non-alcoholic fatty liver disease (NAFLD), metabolic syndrome and cardiovascular events in atrial fibrillation. A prospective multicenter cohort study.

Author

Pastori D, Sciacqua A, Marcucci R, Del Ben M, Baratta F, Violi F, and Pignatelli P

Subjects
Aged, Aged, 80 and over, Atrial Fibrillation epidemiology, Cardiovascular Diseases epidemiology, Cohort Studies, Correlation of Data, Female, Humans, Italy epidemiology, Male, Metabolic Syndrome epidemiology, Non-alcoholic Fatty Liver Disease epidemiology, Proportional Hazards Models, Prospective Studies, Risk Factors, Atrial Fibrillation etiology, Cardiovascular Diseases complications, Metabolic Syndrome complications, Non-alcoholic Fatty Liver Disease complications
Abstract

Whether non-alcoholic fatty liver disease (NAFLD) is associated with an increased risk of cardiovascular events (CVEs) independently from metabolic syndrome (MetS) is still matter of debate. Aim of the study was to investigate the risk of CVEs in a high-risk population of patients with non-valvular atrial fibrillation (AF) according to the presence of MetS and NAFLD. Prospective observational multicenter study including 1,735 patients with non-valvular AF treated with vitamin K antagonists (VKAs) or direct oral anticoagulants (DOACs). NAFLD was defined by a fatty liver index ≥ 60. We categorized patients in 4 groups: 0 = neither MetS or NAFLD (38.6%), 1 = NAFLD alone (12.4%), 2 = MetS alone (19.3%), 3 = both MetS and NAFLD (29.7%). Primary endpoint was a composite of CVEs. Mean age was 75.4 ± 9.4 years, and 41.4% of patients were women. During a mean follow-up of 34.1 ± 22.8 months (4,926.8 patient-years), 155 CVEs were recorded (incidence rate of 3.1%/year): 55 occurred in Group 0 (2.92%/year), 12 in Group 1 (2.17%/year), 45 in Group 2 (4.58%/year) and 43 in Group 3 (2.85%/year). Multivariable Cox regression analysis showed that use of DOACs, and female sex were inversely associated with CVEs, whilst age, heart failure, previous cardiac and cerebrovascular events, and group 2 (Group 2, Hazard Ratio 1.517, 95% Confidence Interval, 1.010-2.280) were directly associated with CVEs. In patients with AF, MetS increases the risk of CVEs. Patients with NAFLD alone have lower cardiovascular risk but may experience higher liver-related complications., (© 2021. The Author(s).)

Published
2021
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2. Statin use and mortality in atrial fibrillation: A systematic review and meta-analysis of 100,287 patients.

Author

Pastori D, Baratta F, Di Rocco A, Farcomeni A, Del Ben M, Angelico F, Violi F, Pignatelli P, and Lip GYH

Subjects
Cardiovascular Diseases mortality, Cardiovascular Diseases prevention & control, Humans, Atrial Fibrillation mortality, Hydroxymethylglutaryl-CoA Reductase Inhibitors therapeutic use
Abstract

Statins are effective for reducing cardiovascular disease in patients at risk or with cardiovascular disease. The benefit of statin therapy on adverse cardiovascular outcomes in patients with non-valvular atrial fibrillation (AF) is not clear. We performed a systematic review and meta-analysis of studies retrieved from MEDLINE via PubMed and Cochrane (CENTRAL) database of studies investigating the efficacy of statins in AF patients. The principal endpoint was all-cause mortality. Other endpoints were cardiovascular mortality, ischemic stroke, composite endpoints and any bleeding. We included 14 studies (2 post-hoc analysis of randomized clinical trials, 8 prospective and 4 retrospective) with 100,287 AF patients, of whom 23,228 were on statins. The pooled hazard ratio (HR) for all-cause mortality was 0.59 (95 % Confidence Interval [CI] 0.54-0.65). This association was consistent by aging, sex and prevalent cardiovascular or cerebrovascular disease. and the beneficial effect was evident already after 12 months of therapy. The absolute risk reduction for all-cause mortality in patients treated with statins was 10 % (95 % CI 9-10). The pooled HR for statins against cardiovascular mortality was 0.75 (95 % CI 0.58-0.96). No association was found with other secondary endpoints. Regarding bleeding events, the pooled HR for statin use was 0.60 (95 % CI 0.48-0.76). Our meta-analysis shows that in AF patients, statin therapy was associated with a reduction in all-cause and cardiovascular mortality are reduced by 41 % and 25 %, respectively. Randomized clinical trials in AF patients are necessary, as well as clarity on AF-specific LDL cholesterol targets., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Published
2021
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3. Prevalence and Impact of Nonalcoholic Fatty Liver Disease in Atrial Fibrillation.

Author

Pastori D, Sciacqua A, Marcucci R, Farcomeni A, Perticone F, Del Ben M, Angelico F, Baratta F, Pignatelli P, and Violi F

Subjects
Aged, Anticoagulants therapeutic use, Atrial Fibrillation drug therapy, Female, Humans, Italy epidemiology, Male, Prevalence, Prospective Studies, Risk Factors, Atrial Fibrillation complications, Non-alcoholic Fatty Liver Disease epidemiology, Non-alcoholic Fatty Liver Disease etiology
Abstract

Objective: To estimate the prevalence of nonalcoholic fatty liver disease (NAFLD) and its impact on bleeding and thrombotic events in patients with atrial fibrillation (AF)., Patients and Methods: Prospective multicenter cohort study including patients with nonvalvular AF receiving vitamin K antagonists (VKAs) or non-VKA oral anticoagulants (NOACs) from February 2008 for patients on VKA and from September 2013 for patients on NOACs. NAFLD was diagnosed using the validated fatty liver index, with a cutoff score of 60 or higher. Primary end points were the occurrence of major bleedings and cardiovascular events (CVEs)., Results: NAFLD was diagnosed in 732 of 1735 (42.2%) patients. Patients with NAFLD were younger, less frequently women, and more likely to be treated with NOACs and to have obesity, dyslipidemia, and persistent/permanent AF. During a median follow-up of 18.7 months (3155 patient-years), we recorded 78 major bleedings (incidence rate, 2.5% per year): 29 (2.1% per year) in patients with and 49 (2.7% per year) in patients without NAFLD (log-rank test P=.23). Univariate Cox proportional regression analysis showed no association of NAFLD with major bleedings (hazard ratio, 0.75; 95% CI, 0.47-1.20; P=.23). One hundred fifty-five CVEs occurred (incidence rate, 3.1% per year). No significant association was found between NAFLD and CVEs (log-rank test P=.12). In the entire population, NOAC use was associated with lower CVEs compared with VKAs (hazard ratio, 0.61; 95% CI, 0.42-0.89; P=.01)., Conclusion: NAFLD is highly prevalent in AF but is not associated with higher bleeding or thrombotic risk., (Copyright © 2019 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.)

Published
2020
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4. Cardiovascular risk stratification in patients with non-valvular atrial fibrillation: the 2MACE score.

Author

Pastori D, Farcomeni A, Poli D, Antonucci E, Angelico F, Del Ben M, Cangemi R, Tanzilli G, Lip GY, Pignatelli P, and Violi F

Subjects
Aged, Aged, 80 and over, Cohort Studies, Female, Humans, Male, Middle Aged, Myocardial Infarction epidemiology, Myocardial Revascularization, Risk Factors, Sensitivity and Specificity, Atrial Fibrillation complications, Atrial Fibrillation mortality
Abstract

Recent findings suggest that patients with non-valvular atrial fibrillation (AF), in addition to having a high risk for ischemic stroke, are also at risk for myocardial infarction (MI). The aim of the study was to combine factors predicting Major Adverse Cardiovascular Events (MACE) in AF patients, including fatal/nonfatal MI, cardiac revascularization, and cardiovascular death, into a simple risk score. Predictors of MACE were obtained from a prospective observational cohort study, including 1019 AF patients taking vitamin K antagonists from the Atherothrombosis Center, of Sapienza University of Rome. Thus, we derived the 2MACE score [2 points for Metabolic Syndrome and Age ≥75, 1 point for MI/revascularization, Congestive heart failure (ejection fraction ≤40 %), thrombo-Embolism (stroke/transient ischemic attack)], ranging from 0 to 7 points. To evaluate the 2MACE score, we included an external validation cohort of 1089 anticoagulated AF patients from the Thrombosis Centre of Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy. At follow-up, 111 AF patients in the internal and 68 in the external cohort experienced a MACE. The 2MACE score showed a good ability in discriminating AF patients experiencing MACE both in the internal derivation cohort, with a c-index of 0.79 [95 % Confidence Interval (CI) 0.71-0.90, p < 0.001] and in the external validation cohort (c-index 0.66, 95 % CI 0.60-0.73, p < 0.001). The overall Hazard Ratio (HR) was 1.61 (95 % CI 1.40-1.85, p < 0.001) for each additional point. A 2MACE score ≥3 had the best combination of specificity and sensitivity, with an HR of 3.92 (95 % CI 2.41-6.40, p < 0.001). The new simple 2MACE score may help identifying AF patients at risk for cardiovascular events.

Published
2016
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5. Inadequate anticoagulation by Vitamin K Antagonists is associated with Major Adverse Cardiovascular Events in patients with atrial fibrillation.

Author

Pastori D, Pignatelli P, Saliola M, Carnevale R, Vicario T, Del Ben M, Cangemi R, Barillà F, Lip GY, and Violi F

Subjects
Acenocoumarol administration & dosage, Acenocoumarol adverse effects, Aged, Aged, 80 and over, Anticoagulants adverse effects, Atrial Fibrillation complications, Atrial Fibrillation physiopathology, Cardiovascular Diseases drug therapy, Female, Follow-Up Studies, Hemorrhage chemically induced, Humans, Male, Myocardial Infarction drug therapy, Patient Outcome Assessment, Proportional Hazards Models, Prospective Studies, Regression Analysis, Stroke drug therapy, Warfarin administration & dosage, Warfarin adverse effects, Anticoagulants administration & dosage, Atrial Fibrillation drug therapy, Cardiovascular Diseases etiology, Vitamin K antagonists & inhibitors
Abstract

Background: Time in therapeutic range (TTR) reflects the quality of anticoagulation and is inversely correlated with ischemic stroke in atrial fibrillation (AF) patients. Few data on the relationship between TTR and myocardial infarction (MI) are available. We investigated the association between TTR and Major Adverse Cardiovascular Events (MACE) in a cohort of anticoagulated AF patients., Methods: We calculated TTR for 627 AF patients on vitamin K antagonists, who were followed for a median of 30.8 months (1755 patients/year). The primary outcome was a combined endpoint of MACE including fatal/nonfatal MI and cardiovascular death., Results: Mean age was 73.3 (±8.2) years, and 40.2% were women. During follow-up, we recorded 67 events: 19 stroke/TIA (1.1%/year) and 48 MACE (2.9%/year): 24 MI and 24 cardiovascular deaths. The cohort was categorized according to tertiles of TTR values: TTR 13-58%, 59-74%, and 75-100%. There was a significant increased rate of MACE across tertiles of TTR (Log-Rank test: p<0.001). On Cox proportion hazard analysis, the 2nd vs. 1st tertile of TTR (p=0.002, hazard ratio [HR] 0.347, confidence interval [CI] 95% 0.177-0.680), 3rd vs. 1st tertile of TTR (p<0.001, HR 0.164, CI 95% 0.067-0.402), age (p<0.001, HR 1.094, CI 95% 1.042-1.148), history of stroke/TIA (p=0.015, HR 2.294, CI 95% 1.172-4.490) and smoking (p=0.003, HR 3.450, CI 95% 1.532-7.769) predicted MACE., Conclusion: TTR was an independent predictor of MACE in our cohort of AF patients. Our findings suggest that a good anticoagulation control is necessary to reduce not only the risk of stroke but also that of MACE., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

Published
2015
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6. Relationship between Mediterranean diet and time in therapeutic range in atrial fibrillation patients taking vitamin K antagonists.

Author

Pignatelli P, Pastori D, Vicario T, Bucci T, Del Ben M, Russo R, Tanzilli A, Nardoni ML, Bartimoccia S, Nocella C, Ferro D, Saliola M, Cangemi R, Lip GY, and Violi F

Subjects
Aged, Comorbidity, Female, Humans, Italy epidemiology, Male, Prevalence, Risk Factors, Survival Rate, Thromboembolism mortality, Treatment Outcome, Anticoagulants administration & dosage, Atrial Fibrillation mortality, Atrial Fibrillation therapy, Diet, Mediterranean statistics & numerical data, Thromboembolism prevention & control, Vitamin K antagonists & inhibitors
Abstract

Aims: It is unclear if atrial fibrillation (AF) patients treated with oral vitamin K antagonists (VKAs) must follow a specific diet to avoid interference with anticoagulation. The aim of this study was to assess if Mediterranean diet (Med-Diet) may affect quality of anticoagulation, as expressed by the time in therapeutic range (TTR)., Methods and Results: A prospective observational study including 553 non-valvular AF patients. Time in therapeutic range was calculated for all patients treated with VKAs, and adherence to Med-Diet was evaluated with a validated nine-item dietary questionnaire. Cardiovascular events (CVEs), such as cardiovascular death and fatal/non-fatal stroke or myocardial infarction, and bleedings were recorded. The median follow-up was 31.6 months. The median number of international normalized ratios for each patient was 63.0 (35.0-98.0) and 38 730 blood samples were analysed. In the whole cohort, the mean TTR was 65.5 ± 17.8%. The mean Med-Diet score was 5.19 ± 1.6, with frequent use of olive oil (90.1%), fruits (88.4%), and vegetables (69.3%) and low meat intake (71.2%). There were no differences among tertiles of Med-Diet score regarding TTR. A multivariable linear regression analysis showed that diabetes (β: -0.105, P = 0.015) and the use of angiotensin converting enzyme inhibitor/angiotensin receptor blockers (β: 0.153, P < 0.001) were associated with TTR. Compared with those without, AF patients with a CVE had significantly lower TTR (65.9 ± 17.9 vs. 59.6 ± 15.9, P = 0.029) and Med-Diet score (5.2 ± 1.5 vs. 4.4 ± 1.9, P = 0.004). A reduction of CVE was observed for each point of the Med-Diet score (hazard ratio 0.790, P = 0.017)., Conclusion: In our cohort of AF patients, Med-Diet is not associated with changes in TTR, and thus can be recommended for AF patients who are taking VKAs., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.)

Published
2015
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7. Incidence of myocardial infarction and vascular death in elderly patients with atrial fibrillation taking anticoagulants: relation to atherosclerotic risk factors.

Author

Pastori D, Pignatelli P, Angelico F, Farcomeni A, Del Ben M, Vicario T, Bucci T, Raparelli V, Cangemi R, Tanzilli G, Lip GYH, and Violi F

Subjects
Age Factors, Aged, Aged, 80 and over, Cohort Studies, Female, Follow-Up Studies, Humans, Incidence, Male, Metabolic Syndrome complications, Metabolic Syndrome epidemiology, Myocardial Infarction therapy, Myocardial Revascularization, Proportional Hazards Models, Prospective Studies, Risk Factors, Survival Rate, Anticoagulants therapeutic use, Atherosclerosis epidemiology, Atrial Fibrillation drug therapy, Cardiovascular Diseases epidemiology, Cardiovascular Diseases mortality, Myocardial Infarction epidemiology
Abstract

Background: Recent findings suggest that patients with atrial fibrillation (AF), in addition being at thromboembolic risk, are at risk of myocardial infarction (MI). Our aim was to investigate predictors of MI and cardiovascular death in a cohort of patients with AF who were taking anticoagulants., Methods: We prospectively followed up 1,019 patients with AF for a median of 33.7 months (3,223 person-years). All patients were treated with oral vitamin K antagonists. Primary outcome was a composite end point of cardiovascular events (CVEs) including fatal/nonfatal MI, cardiac revascularization, and cardiovascular death., Results: The mean age of the patients was 73.2 years, and 43.8% were women. At follow-up, 111 CVEs (3.43%/y) had occurred: 47 fatal-nonfatal MI/revascularization and 64 cardiovascular deaths. In addition, 31 stroke/transient ischemic attacks (0.96%/y) were recorded. Patients experiencing CVEs were older (P < .001) and had a higher prevalence of metabolic syndrome (MetS) (P = .005), heart failure (P = .001), and prior cardiac (P < .001) and cerebrovascular events (P < .001). On a Cox proportional hazard analysis, age (hazard ratio [HR], 1.083; 95% CI, 1.053-1.113; P < .001), smoking (HR, 2.158; 95% CI, 1.193-3.901; P = .011), history of cerebrovascular (HR, 1.704; 95% CI, 1.119-2.597; P = .013) and cardiac (HR, 1.658; 95% CI, 1.105-2.489; P = .015) events, MetS (HR, 1.663; 95% CI, 1.107-2.499; P = .014), heart failure (HR, 1.584; 95% CI, 1.021-2.456; P = .040), and male sex (HR, 1.499; 95% CI, 1.010-2.223; P = .044) predicted CVEs., Conclusions: Patients with AF still experience a high rate of CVEs despite receiving anticoagulant treatment. MetS is a common clinical feature in patients with AF, which increases the risk of CVEs. A holistic approach is needed to reduce the cardiovascular risk in patients with AF., Trial Registry: ClinicalTrials.gov; No.: NCT01882114; URL: www.clinicaltrials.gov.

Published
2015
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8. Frequency of Left Ventricular Hypertrophy in Non-Valvular Atrial Fibrillation

Author

Proietti M, Marra AM, Tassone EJ, De Vuono S, Corrao S, Gobbi P, Perticone F, Corazza GR, Basili S, Lip GY, Violi F, Raparelli V, ARAPACIS Study Investigators, GIS Group, Alessandri Cesare, Serviddio Gaetano, Fascetti Stefano, Serra Pietro, Palange Paolo, Greco Eleonora, Bruno Graziella, Averna Maurizio, Giammanco Antonina, Sposito Pietro, De Cristofaro Raimondo, De Gennaro Leonardo, Loria Paola, Pellegrini Elisa, Cominacini Luciano, Mozzini Chiara, Sprovieri Mario, Spagnuolo Vitaliano, Cerqua Giannantonio, Cerasola Giovanni, Mulé Giuseppe, Barbagallo Mario, Lo Sciuto Salvatore, Monteverde Alfredo, Saitta Antonino, Lo Gullo Alberto, Malatino Lorenzo, Cilia Chiara, Licata Giuseppe, Tuttolomondo Antonino, Conigliaro Roberta, Pinto Antonio, Di Raimondo Domenico, Signorelli Santo, Anzaldi Massimiliano, De Palma Daniela, Galderisi Maurizio, Cudemo Giuseppe, Galletti Ferruccio, Fazio Valeria, De Luca Nicola, Meccariello Alfonso, Caputo Dario, De Donato Maria Teresa, Iannuzi Arcangelo, Bresciani Alessandro, Giunta Riccardo, Cimini Claudia, Durante Mangoni Emanuele, Agrusta Federica, Iorio Federica, Adinolfi Luigi E, Sellitto Ausilia, Restivo Luciano, Bellis Paolo, Tirelli Paolo, Sacerdoti David, Pesce Paola, Vanni Dino, Iuliano Luigi, Ciacciarelli Marco, Pacelli Antonio, Palazzuoli Alberto, Cacciafesta Mauro, Gueli Nicola, Capeci William, Tarquinio Nicola, Pellegrini Francesco, Vincentelli Giovanni Maria, Ravallese Ferdinando, Santini Claudio, Letizia Claudio, Petramala Luigi, Zinnamosca Laura, Cilli Mirella, Savoriti Claudio, Falaschi Paolo, Martocchia Antonio, Stefanelli Manuela, Marigliano Vincenzo, Lo Iacono Cristina, Brusco Simona, Bertazzoni Giuliano, Attalla El Halabieh Elias, Paradiso Michele, Lizzi Eugenio Maria, Timmi Stefano, Battisti Paola, Cerci Sabina, Ciavolella Massimo, Di Veroli Claudio, Malci Francesco, De Ciocchis Anita, Abate Damiano, Castellino Pietro, Curto Irene, Vecchio Claudia, Mannarino Elmo, Pasqualini Leonella, Fattori Chiara, Pende Aldo, Denegri Andrea, Artom Nathan, Ricchio Roberto, Fimognari Filippo Luca, Alletto Maurizio, Messina Simona, Sesti Giorgio, Arturi Franco, Grembiale Alessandro, Perticone Francesco, Maio Raffaele, Scarpino Paola Elisa, Carullo Giuseppe, Sciacqua Angela, Frugiuele Pierluigi, Battaglia Giuseppe, Vidili Gianpaolo, Atzori Sebastiana, Delitala Giuseppe, Davì Giovanni, Angelucci Ermanno, Sestili Simona, Traisci Giancarlo, De Feudis Lucrezia, Di Michele Dario, Fava Alessandra, Balsano Clara, De Ciantis Pierpaolo, Desideri Giovambattista, Camerota Antonio, Migliacci Rino, Porciello Giovanni, Mezzetti Matteo, Gresele Paolo, Vedovati Cristina, Fierro Tiziana, Puccetti Luca, Scarpini Francesca, Bertolotti Marco, Mussi Chiara, Boddi Maria, Savino Andrea, Contri Silvia, Saller Alois, Fabris Fabrizio, Pesavento Raffaele, Filippi Lucia, Vedovetto Valentina, Puato Massimo, Treleani Martina, De Luca Elisabetta, De Zaiacomo Francesca, Giantin Valter, Semplicini Andrea, Minuz Pietro, Calabria Stefano, Romano Simone, Fantin Francesco, Manica Angela, Stockner Ingrid, Pattis Peter, Gutmann Bernhard, Catena Cristiana, Colussi GianLuca, Annoni Giorgio, Bruni Adriana Antonella, Castagna Alberto, Spinelli Diana, Corazza Gino Roberto, Miceli Emanuela, Padula, Schinco Giuseppina, Spreafico Sibilla, Secchi Beatrice, Vanoli Massimo, Casella Gianluca, Serra Maria Grazia, Longo Stefania, Antonaci Salvatore, Belfiore Anna, Ricci Lara, Ventrella Francesco, Iamele Luigi, Bianco Cesare, Santovito Donato, Cipollone Francesco, Nicolai Salvatore, Salvati Filippo, Rini Giovan Battista, Scozzari Francesca, Muiesan Maria Lorenza, Salvetti Massimo, Bazza Abramo, Picardi Antonio, De Vincentis Antonio, Cosio Paolo, Terzolo Massimo, Madaffari Bruno, Parasporo Bruno, Fenoglio Luigi, Bracco Christian, Melchio Remo, Gentili Tamira, Salvi Aldo, Nitti Cinzia, Falsetti L, Gabrielli Armando, Paglione Ivano, Capucci Alessandro, Brambatti Michela, Sparagna Armando, Tirotta Daniela, Andreozzi Paola, Ettorre Evaristo, Viscogliosi Giovanni, Rossi Fanelli Fillippo, Delfino Massimo, Glorioso Nicola, Melis Giada, Marras Gianfranca, Matta Michela, Sacco Andrea, Stellitano Elio, Scordo Anna, Russo Franco, Caruso Assunta Antonietta, Porreca Ettore, Santilli Francesca, Tana Marco, Ferri Claudio, Grassi Davide, Cheli Paola, Portincasa Piero, Muscianisi Giuseppe, Giordani Sara, Stanghellini Vincenzo, Sabbà Carlo, Suppressa Patrizia, Mancuso Gerardo, Bartone Mosè, Calipari Daniela, Arcidiacono Giuseppe, Bellanuova Ignazio, Ferraro Maria, Scalzo Antonio, Marigliano Giampietro, Cozzolino Domenico, Lampitella Antonio, Acri Vera, Galasso Domenico, Mazzei Francesca, Galasso Salvatore, Buratti Alberto, Porta Massimo, Brizzi Maria Felice, Fattorini Annalisa, Sampietro Francesca, D’Angelo Armando, Pala Marco, Fabbian Fabio, Manfredini Roberto, Moroni Carlo, Valente Lucia, Lopreiato Francesco, Parente Fernando, Moia Marco, Braham Simon, Rossi Marco, Pesce Margherita, Gentile Adelina, Catozzo Vania, Di Napoli Mariarosaria, Baciarello Giacinto, Rancan Elena, Ageno Walter, Guasti Luigina, Ciccaglioni Antonio, Negri Silvia, Polselli Marco, Abbate Rosanna, Marcucci Rossella, Cangemi Roberto, Pignataro Francesca Serena, Marco Proietti, Pastori Daniele, Ferro Domenico, Loffredo Lorenzo, Perri Ludovica, Catasca Elisa, Raparelli Valeria, Napoleone Laura, Talerico Giovanni, Calvieri Camilla, Vicario Tommasa, Russo Roberta, Saliola Mirella, Del Ben Maria, Angelico Francesco, Bucci Tommaso, Baratta Francesco, DATA AND SAFETY MONITORING BOARD (DSMB): Vestri Anna Rita, Farcomeni Alessio, Di Tanna Gianluca, STUDY COORDINATORS: Basili Stefania, Davi’ Giovanni, STEERING COMMITTEE OF ARAPACIS STUDY: Violi Francesco, Lip Gregory YH, Hiatt William R, Vestri Anna Rita, Mannucci Pier Mannuccio, Proietti Marco, Bazzini Cristina, Bianchi Paola Ilaria, Boari Benedetta, Buonauro Agostino, Buttà Carmelo, Buzzetti Elena, Carleo Pietro, Carrabba Maria Domenica, Castorani Luigi, Cecchetto Lara, Colombo Barbara Maria, De Giorgi Alfredo, De Vuono Stefano, Del Corso Lisette, Di Giosia Paolo, Falsetti Lorenzo, Forgione Alessandra, Hijazi Daniel, Lorusso Giusi, Marra Alberto Maria, Masala Maristella, Montebianco Abenavoli Ludovico, Murgia Giuseppe, Naccarato Paola, Pattoneri Paolo, Perego Francesca, Pinto Daniela, Pinna Miriam Pretti Vincenzo, Pucci Giacomo, Salinaro Francesco, Sirico Domenico, Tassone Eliezer Joseph, Torres Daniele, Vazzana Natale, Vecchio Claudia Rita, Vitale Francesco, Proietti M, Marra AM, Tassone EJ, De Vuono S, Corrao S, Gobbi P, Perticone F, Corazza GR, Basili S, Lip GY, Violi F, Raparelli V, ARAPACIS Study Investigators, GIS Group, Alessandri Cesare, Serviddio Gaetano, Fascetti Stefano, Serra Pietro, Palange Paolo, Greco Eleonora, Bruno Graziella, Averna Maurizio, Giammanco Antonina, Sposito Pietro, De Cristofaro Raimondo, De Gennaro Leonardo, Loria Paola, Pellegrini Elisa, Cominacini Luciano, Mozzini Chiara, Sprovieri Mario, Spagnuolo Vitaliano, Cerqua Giannantonio, Cerasola Giovanni, Mulé Giuseppe, Barbagallo Mario, Lo Sciuto Salvatore, Monteverde Alfredo, Saitta Antonino, Lo Gullo Alberto, Malatino Lorenzo, Cilia Chiara, Licata Giuseppe, Tuttolomondo Antonino, Conigliaro Roberta, Pinto Antonio, Di Raimondo Domenico, Signorelli Santo, Anzaldi Massimiliano, De Palma Daniela, Galderisi Maurizio, Cudemo Giuseppe, Galletti Ferruccio, Fazio Valeria, De Luca Nicola, Meccariello Alfonso, Caputo Dario, De Donato Maria Teresa, Iannuzi Arcangelo, Bresciani Alessandro, Giunta Riccardo, Cimini Claudia, Durante Mangoni Emanuele, Agrusta Federica, Iorio Federica, Adinolfi Luigi E, Sellitto Ausilia, Restivo Luciano, Bellis Paolo, Tirelli Paolo, Sacerdoti David, Pesce Paola, Vanni Dino, Iuliano Luigi, Ciacciarelli Marco, Pacelli Antonio, Palazzuoli Alberto, Cacciafesta Mauro, Gueli Nicola, Capeci William, Tarquinio Nicola, Pellegrini Francesco, Vincentelli Giovanni Maria, Ravallese Ferdinando, Santini Claudio, Letizia Claudio, Petramala Luigi, Zinnamosca Laura, Cilli Mirella, Savoriti Claudio, Falaschi Paolo, Martocchia Antonio, Stefanelli Manuela, Marigliano Vincenzo, Lo Iacono Cristina, Brusco Simona, Bertazzoni Giuliano, Attalla El Halabieh Elias, Paradiso Michele, Lizzi Eugenio Maria, Timmi Stefano, Battisti Paola, Cerci Sabina, Ciavolella Massimo, Di Veroli Claudio, Malci Francesco, De Ciocchis Anita, Abate Damiano, Castellino Pietro, Curto Irene, Vecchio Claudia, Mannarino Elmo, Pasqualini Leonella, Fattori Chiara, Pende Aldo, Denegri Andrea, Artom Nathan, Ricchio Roberto, Fimognari Filippo Luca, Alletto Maurizio, Messina Simona, Sesti Giorgio, Arturi Franco, Grembiale Alessandro, Perticone Francesco, Maio Raffaele, Scarpino Paola Elisa, Carullo Giuseppe, Sciacqua Angela, Frugiuele Pierluigi, Spagnuolo Vitaliano, Battaglia Giuseppe, Vidili Gianpaolo, Atzori Sebastiana, Delitala Giuseppe, Davì Giovanni, Angelucci Ermanno, Sestili Simona, Traisci Giancarlo, De Feudis Lucrezia, Di Michele Dario, Fava Alessandra, Balsano Clara, De Ciantis Pierpaolo, Desideri Giovambattista, Camerota Antonio, Migliacci Rino, Porciello Giovanni, Mezzetti Matteo, Gresele Paolo, Vedovati Cristina, Fierro Tiziana, Puccetti Luca, Scarpini Francesca, Bertolotti Marco, Mussi Chiara, Boddi Maria, Savino Andrea, Contri Silvia, Saller Alois, Fabris Fabrizio, Pesavento Raffaele, Filippi Lucia, Vedovetto Valentina, Puato Massimo, Fabris Fabrizio, Treleani Martina, De Luca Elisabetta, De Zaiacomo Francesca, Giantin Valter, Semplicini Andrea, Minuz Pietro, Calabria Stefano, Romano Simone, Fantin Francesco, Manica Angela, Stockner Ingrid, Pattis Peter, Gutmann Bernhard, Catena Cristiana, Colussi GianLuca, Annoni Giorgio, Bruni Adriana Antonella, Castagna Alberto, Spinelli Diana, Corazza Gino Roberto, Miceli Emanuela, Padula, Schinco Giuseppina, Spreafico Sibilla, Secchi Beatrice, Vanoli Massimo, Casella Gianluca, Serra Maria Grazia, Longo Stefania, Antonaci Salvatore, Belfiore Anna, Ricci Lara, Ventrella Francesco, Iamele Luigi, Bianco Cesare, Santovito Donato, Cipollone Francesco, Nicolai Salvatore, Salvati Filippo, Rini Giovan Battista, Scozzari Francesca, Muiesan Maria Lorenza, Salvetti Massimo, Bazza Abramo, Picardi Antonio, De Vincentis Antonio, Cosio Paolo, Terzolo Massimo, Madaffari Bruno, Parasporo Bruno, Fenoglio Luigi, Bracco Christian, Melchio Remo, Gentili Tamira, Salvi Aldo, Nitti Cinzia, Falsetti L, Gabrielli Armando, Paglione Ivano, Capucci Alessandro, Brambatti Michela, Sparagna Armando, Tirotta Daniela, Andreozzi Paola, Ettorre Evaristo, Viscogliosi Giovanni, Rossi Fanelli Fillippo, Delfino Massimo, Glorioso Nicola, Melis Giada, Marras Gianfranca, Matta Michela, Sacco Andrea, Stellitano Elio, Scordo Anna, Russo Franco, Caruso Assunta Antonietta, Porreca Ettore, Santilli Francesca, Tana Marco, Ferri Claudio, Grassi Davide, Cheli Paola, Portincasa Piero, Muscianisi Giuseppe, Giordani Sara, Stanghellini Vincenzo, Sabbà Carlo, Suppressa Patrizia, Mancuso Gerardo, Bartone Mosè, Calipari Daniela, Arcidiacono Giuseppe, Bellanuova Ignazio, Ferraro Maria, Scalzo Antonio, Marigliano Giampietro, Cozzolino Domenico, Lampitella Antonio, Acri Vera, Galasso Domenico, Mazzei Francesca, Galasso Salvatore, Buratti Alberto, Porta Massimo, Brizzi Maria Felice, Fattorini Annalisa, Sampietro Francesca, D’Angelo Armando, Pala Marco, Fabbian Fabio, Manfredini Roberto, Moroni Carlo, Valente Lucia, Lopreiato Francesco, Parente Fernando, Moia Marco, Braham Simon, Rossi Marco, Pesce Margherita, Gentile Adelina, Catozzo Vania, Di Napoli Mariarosaria, Baciarello Giacinto, Rancan Elena, Ageno Walter, Guasti Luigina, Ciccaglioni Antonio, Negri Silvia, Polselli Marco, Abbate Rosanna, Marcucci Rossella, Cangemi Roberto, Pignataro Francesca Serena, Marco Proietti, Pastori Daniele, Ferro Domenico, Loffredo Lorenzo, Perri Ludovica, Catasca Elisa, Raparelli Valeria, Napoleone Laura, Talerico Giovanni, Calvieri Camilla, Vicario Tommasa, Russo Roberta, Saliola Mirella, Del Ben Maria, Angelico Francesco, Bucci Tommaso, Baratta Francesco, DATA AND SAFETY MONITORING BOARD (DSMB): Vestri Anna Rita, Farcomeni Alessio, Di Tanna Gianluca, STUDY COORDINATORS: Basili Stefania, Davi’ Giovanni, STEERING COMMITTEE OF ARAPACIS STUDY: Violi Francesco, Perticone Francesco, Lip Gregory YH, Hiatt William R, Vestri Anna Rita, Corazza Gino Roberto, Mannucci Pier Mannuccio, Licata Giuseppe, Moroni Carlo, Proietti Marco, Anzaldi Massimiliano, Bazzini Cristina, Bianchi Paola Ilaria, Boari Benedetta, Bracco Christian, Buonauro Agostino, Buttà Carmelo, Buzzetti Elena, Calabria Stefano, Capeci William, Carleo Pietro, Carrabba Maria Domenica, Castorani Luigi, Cecchetto Lara, Cimini Claudia, Colombo Barbara Maria, De Giorgi Alfredo, De Vuono Stefano, Denegri Andrea, Del Corso Lisette, Di Giosia Paolo, Durante Mangoni Emanuele, Falsetti Lorenzo, Forgione Alessandra, Grassi Davide, Grembiale Alessandro, Hijazi Daniel, Iamele Luigi, Lorusso Giusi, Marra Alberto Maria, Masala Maristella, Montebianco Abenavoli Ludovico, Murgia Giuseppe, Naccarato Paola, Pattoneri Paolo, Perego Francesca, Pesce Paola, Petramala Luigi, Pinto Daniela, Pinna Miriam Pretti Vincenzo, Pucci Giacomo, Raparelli Valeria, Salinaro Francesco, Santilli Francesca, Scarpini Francesca, Sirico Domenico, Suppressa Patrizia, Tassone Eliezer Joseph, Torres Daniele, Vazzana Natale, Vecchio Claudia Rita, Vidili Gianpaolo, Vitale Francesco, Proietti, M., Marra, A., Tassone, E., De Vuono, S., Corrao, S., Gobbi, P., Perticone, F., Corazza, G., Basili, S., Lip, G., Violi, F., Raparelli, V., Marra, A. M., Tassone, E. J., Corazza, G. R., and Lip, G. Y. H.

Subjects
Registrie, Male, Cross-sectional study, Myocardial Infarction, Longitudinal Studie, Left ventricular hypertrophy, Cohort Studies, non-valvular atrial fibrillation, Atrial Fibrillation, 80 and over, Prevalence, echocardiography, Myocardial infarction, Longitudinal Studies, Prospective Studies, Registries, Prospective cohort study, Ultrasonography, Aged, 80 and over, education.field_of_study, Medicine (all), Atrial fibrillation, Diabetes Mellitu, Middle Aged, Left Ventricular, left ventricular hypertrophy, Italy, Hypertension, Cardiology, Age Distribution, Aged, Ankle Brachial Index, Cross-Sectional Studies, Diabetes Mellitus, Female, Humans, Hypertrophy, Left Ventricular, Logistic Models, Peripheral Arterial Disease, Cardiology and Cardiovascular Medicine, Human, medicine.medical_specialty, Logistic Model, Population, Concentric hypertrophy, Socio-culturale, non-valvular atrial fibrillation, left ventricular hypertrophy, echocardiography, cardiovascular diseases, Internal medicine, medicine, cardiovascular diseases, education, Cross-Sectional Studie, business.industry, Odds ratio, Hypertrophy, medicine.disease, Prospective Studie, Cohort Studie, business
Abstract

Left ventricular hypertrophy (LVH) is significantly related to adverse clinical outcomes in patients at high risk of cardiovascular events. In patients with atrial fibrillation (AF), data on LVH, that is, prevalence and determinants, are inconsistent mainly because of different definitions and heterogeneity of study populations. We determined echocardiographic-based LVH prevalence and clinical factors independently associated with its development in a prospective cohort of patients with non-valvular (NV) AF. From the "Atrial Fibrillation Registry for Ankle-brachial Index Prevalence Assessment: Collaborative Italian Study" (ARAPACIS) population, 1,184 patients with NVAF (mean age 72 ± 11 years; 56% men) with complete data to define LVH were selected. ARAPACIS is a multicenter, observational, prospective, longitudinal on-going study designed to estimate prevalence of peripheral artery disease in patients with NVAF. We found a high prevalence of LVH (52%) in patients with NVAF. Compared to those without LVH, patients with AF with LVH were older and had a higher prevalence of hypertension, diabetes, and previous myocardial infarction (MI). A higher prevalence of ankle-brachial index ≤0.90 was seen in patients with LVH (22 vs 17%, p = 0.0392). Patients with LVH were at significantly higher thromboembolic risk, with CHA2DS2-VASc ≥2 seen in 93% of LVH and in 73% of patients without LVH (p

Published
2015

9. Incidence of myocardial infarction and vascular death in elderly patients with atrial fibrillation taking anticoagulants: relation to atherosclerotic risk factors

Author

Pastori, Daniele, Pignatelli, Pasquale, Angelico, Francesco, Farcomeni, Alessio, DEL BEN, Maria, Vicario, Tommasa, Bucci, T., Raparelli, Valeria, Cangemi, Roberto, Tanzilli, Gaetano, Lip, G., and Violi, Francesco

Subjects
Aged, 80 and over, Male, Metabolic Syndrome, Incidence, Age Factors, Myocardial Infarction, Anticoagulants, Atherosclerosis, NO, Cohort Studies, Survival Rate, Cardiovascular Diseases, Risk Factors, Oral Anticoagulants, Atrial Fibrillation, Myocardial Revascularization, Humans, Prospective study, Female, Prospective Studies, Aged, Follow-Up Studies, Proportional Hazards Models
Abstract

Recent findings suggest that patients with atrial fibrillation (AF), in addition being at thromboembolic risk, are at risk of myocardial infarction (MI). Our aim was to investigate predictors of MI and cardiovascular death in a cohort of patients with AF who were taking anticoagulants.We prospectively followed up 1,019 patients with AF for a median of 33.7 months (3,223 person-years). All patients were treated with oral vitamin K antagonists. Primary outcome was a composite end point of cardiovascular events (CVEs) including fatal/nonfatal MI, cardiac revascularization, and cardiovascular death.The mean age of the patients was 73.2 years, and 43.8% were women. At follow-up, 111 CVEs (3.43%/y) had occurred: 47 fatal-nonfatal MI/revascularization and 64 cardiovascular deaths. In addition, 31 stroke/transient ischemic attacks (0.96%/y) were recorded. Patients experiencing CVEs were older (P.001) and had a higher prevalence of metabolic syndrome (MetS) (P = .005), heart failure (P = .001), and prior cardiac (P.001) and cerebrovascular events (P.001). On a Cox proportional hazard analysis, age (hazard ratio [HR], 1.083; 95% CI, 1.053-1.113; P.001), smoking (HR, 2.158; 95% CI, 1.193-3.901; P = .011), history of cerebrovascular (HR, 1.704; 95% CI, 1.119-2.597; P = .013) and cardiac (HR, 1.658; 95% CI, 1.105-2.489; P = .015) events, MetS (HR, 1.663; 95% CI, 1.107-2.499; P = .014), heart failure (HR, 1.584; 95% CI, 1.021-2.456; P = .040), and male sex (HR, 1.499; 95% CI, 1.010-2.223; P = .044) predicted CVEs.Patients with AF still experience a high rate of CVEs despite receiving anticoagulant treatment. MetS is a common clinical feature in patients with AF, which increases the risk of CVEs. A holistic approach is needed to reduce the cardiovascular risk in patients with AF.ClinicalTrials.gov; No.: NCT01882114; URL: www.clinicaltrials.gov.

Published
2015

10. Prevalence of peripheral artery disease by abnormal ankle-brachial index in atrial fibrillation: implications for risk and therapy

Author

Violi, Francesco, Davì, G., Hiatt, W., Lip, G. Y. H., Corazza, Giuseppe Romolo, Perticone, F., Proietti, Marco, Pignatelli, Pasquale, Vestri, Anna Rita, Basili, Stefania, Falaschi, Paolo, Granata, Massimo, DEL BEN, Maria, Angelico, Francesco, Violi, F, Daví, G, Hiatt, W, Lip, Gy, Corazza, Gr, Perticone, F, Proietti, M, Pignatelli, P, Vestri, Ar, Basili, S, DI MINNO, Giovanni, Galderisi, Maurizio, DE LUCA, Nicola, and Galletti, Ferruccio

Subjects
Adult, Male, Risk, Middle Aged, Peripheral Arterial Disease, atrial fibrillation, cardiovascular disease, peripheral vascular disease, Aged, Atrial Fibrillation, Female, Humans, Internal Medicine, Italy, Prevalence, Registries, Societies, Medical, Ankle Brachial Index, Cardiology and Cardiovascular Medicine, Medical, Societies
Published
2013

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