Background:Non-valvular atrial fibrillation(NVAF),the most prevalent cardiac arrhythmia globally,poses a dual challenge of thromboembolic and bleeding risks,with stroke being the most devastating complication.Despite ...Background:Non-valvular atrial fibrillation(NVAF),the most prevalent cardiac arrhythmia globally,poses a dual challenge of thromboembolic and bleeding risks,with stroke being the most devastating complication.Despite advancements in anticoagulation and rhythm control,patient outcomes remain suboptimal.Aim:This review synthesizes current evidence on the pathophysiological mechanisms,multidimensional management strategies,and emerging innovations in NVAF to inform clinical practice and future research directions.Methods:A systematic literature search was conducted across nine databases(CNKI,Wanfang,SinoMed,VIP,PubMed,Web of Science,Cochrane Library,Embase,and MEDLINE)using combined Medical Subject Headings(MeSH)and free-text terms,including“atrial fibrillation,”“non-valvular atrial fibrillation,”“risk factors,”and“mechanism”(and their Chinese equivalents).Studies on NVAF pathogenesis,therapeutic interventions,and risk stratification tools were analyzed.Results:(1)Risk Factors and Pathophysiology:NVAF progression is driven by hemodynamic stress(e.g.,hypertension),metabolic disorders(e.g.,obesity,diabetes),chronic inflammation,and fibrosis.Biomarkers such as CRP and Galectin-3,along with TGF-β/Smad signaling,are central to atrial remodeling.(2)Anticoagulation Controversies:While NOACs reduce stroke risk compared to warfarin(HR=0.79),challenges persist in extreme body weight populations and drug-drug interactions(e.g.,with P-glycoprotein inhibitors).(3)Left Atrial Appendage Closure(LAAC):LAAC demonstrates non-inferiority to anticoagulation in stroke prevention(HR=0.79)with reduced major bleeding(HR=0.49),though device-related thrombosis(1.8–7%)remains a concern.(4)Precision Medicine:AI-driven models enhance stroke prediction(AUC=0.71;sensitivity 92%),while genotype-guided warfarin dosing shortens INR stabilization by 40%.(5)Lifestyle Interventions:Combined Mediterranean diet and moderate exercise reduce AF burden(HR=0.69)and reverse left atrial enlargement(LAVI reduced by 12%).(6)Multidisciplinary Care:Integrated“heart-brain team”approaches combining LAAC and PFO closure lower annual stroke recurrence from 8.2%to 2.1%,while comprehensive rehabilitation improves functional capacity(6MWD+45 m)and quality of life(SF-36+12 points).Conclusion:NVAF management has evolved from isolated anticoagulation to a multidimensional paradigm integrating genomics,AI,and lifestyle modification.Future priorities include validating long-term outcomes of novel therapies,addressing evidence gaps in special populations,and implementing digitally enabled,cross-disciplinary care models to mitigate the global burden of NVAF-related complications.展开更多
Background：Metabolic syndrome （MS） is a risk factor for stroke and thromboembolism event.Left atrial or LA appendage （LA/LAA） thrombus is a surrogate of potential stroke.The relationship between MS and atrial thr...Background：Metabolic syndrome （MS） is a risk factor for stroke and thromboembolism event.Left atrial or LA appendage （LA/LAA） thrombus is a surrogate of potential stroke.The relationship between MS and atrial thrombus remains unclear.In this study,we sought to investigate the effect of MS on risk stratification of LA/LAA thrombus formation in patients with nonvalvular atrial fibrillation （NVAF）.Methods：This cross-sectional study enrolled 294 consecutive NVAF patients without prior anticoagulant and lipid-lowering therapies.LA/LAA thrombus was determined by transesophageal echocardiography.Risk assessment of LA/LAA thrombus was performed using the CHADS2,CHA2DS2-VASc,MS,CHADS2-MS,and CHA2DS2-VASc-MS scores.Logistic regression analyses were performed to determine which factors were significantly related to LA/LAA thrombus.Odds ratio （OR） including 95% confidence interval was also calculated.The predictive powers of different scores for the risk of LA/LAA thrombus were represented by C-statistics and compared by receiver operating characteristic （ROC） analysis.Results：LA/LAA thrombi were identified in 56 patients （19.0%）.Logistic analysis showed that MS was the strongest risk factor for LA/LAA thrombus in NVAF patients （OR =14.698,P 〈 0.001）.ROC curve analyses revealed that the C-statistics of CHADS2-MS and CHA2DS2-VASc-MS was significantly higher than those of CHADS2 and CHA2DS2-VASc scores （CHADS2-MS vs.CHADS2,0.807 vs.0.726,P=0.0019）.Furthermore,MS was helpful for identifying individuals with a high risk of LA/LAA thrombus in the population with a low risk of stroke （CHADS2 or CHA2DS2-VASc score =0）.Conclusions：MS is associated with LA/LAA thrombus risk in patients with NVAF.In addition to the CHADS2 and CHA2DS2-VASc scores,the CHADS2-MS and CHA2DS2-VASc-MS scores provide additional information on stroke risk assessment.展开更多
Background:Warfarin is the most common oral anticoagulant to decrease the stroke risk associated with atrial fibrillation(AF).There are very few prospective studies that have explored whether warfarin has an associati...Background:Warfarin is the most common oral anticoagulant to decrease the stroke risk associated with atrial fibrillation(AF).There are very few prospective studies that have explored whether warfarin has an association with damage on renal function in Chinese patients with nonvalvular AF(NVAF).The aim of this study was to evaluate the effects of warfarin on renal function and study the factors associated with kidney dysfunction in Chinese adult NVAF patients without dialysis therapy.Methods:From January 2011 to December 2013,a total of 951 NVAF patients from 18 hospitals were enrolled.The estimated glomerular filtration rate(eGFR)was calculated from baseline and fbllow-up serum creatinine levels.Kaplan-Meier survival curves compared the survival of a〉25%decline in eGFR(hereafter,endpoint)~while Cox models estimated hazard ratios(HRs)and 95%confidence intervals for this event after adjustment for age,gender,and selected potential risk factors for renal dysfunction.Cox regression analysis of the various clinical potential variables was performed to identify the predictors of a-〉25%decline in eGFR.Results:After a 58-month follow-up,951 NVAF patients were divided by observation into warfarin(n=655)and no anticoagulation groups(n=296)and 120(12.6%)patients experienced renal endpoint.Kaplan-Meier survival curves showed that the survival period was not different in the two groups(χ2=0.178,log-rank P=0.67),but patients with systolic blood pressure(SBP)〈140 mmHg have significant difference with patients with SBP≥140 mmHg(χ2=4.903,log-rank P=0.03).Multivariate Cox regression analysis revealed baseline eGFR and SBP as independent predictors of the endpoint,with HRs of 1.00,and 1.02,respectively.Conclusion:In patients with NVAF,eGFR and SBP are associated with the deterioration of kidney function while Warfarin is not the risk factor of the≥25%decline in eGFR.展开更多
文摘Background:Non-valvular atrial fibrillation(NVAF),the most prevalent cardiac arrhythmia globally,poses a dual challenge of thromboembolic and bleeding risks,with stroke being the most devastating complication.Despite advancements in anticoagulation and rhythm control,patient outcomes remain suboptimal.Aim:This review synthesizes current evidence on the pathophysiological mechanisms,multidimensional management strategies,and emerging innovations in NVAF to inform clinical practice and future research directions.Methods:A systematic literature search was conducted across nine databases(CNKI,Wanfang,SinoMed,VIP,PubMed,Web of Science,Cochrane Library,Embase,and MEDLINE)using combined Medical Subject Headings(MeSH)and free-text terms,including“atrial fibrillation,”“non-valvular atrial fibrillation,”“risk factors,”and“mechanism”(and their Chinese equivalents).Studies on NVAF pathogenesis,therapeutic interventions,and risk stratification tools were analyzed.Results:(1)Risk Factors and Pathophysiology:NVAF progression is driven by hemodynamic stress(e.g.,hypertension),metabolic disorders(e.g.,obesity,diabetes),chronic inflammation,and fibrosis.Biomarkers such as CRP and Galectin-3,along with TGF-β/Smad signaling,are central to atrial remodeling.(2)Anticoagulation Controversies:While NOACs reduce stroke risk compared to warfarin(HR=0.79),challenges persist in extreme body weight populations and drug-drug interactions(e.g.,with P-glycoprotein inhibitors).(3)Left Atrial Appendage Closure(LAAC):LAAC demonstrates non-inferiority to anticoagulation in stroke prevention(HR=0.79)with reduced major bleeding(HR=0.49),though device-related thrombosis(1.8–7%)remains a concern.(4)Precision Medicine:AI-driven models enhance stroke prediction(AUC=0.71;sensitivity 92%),while genotype-guided warfarin dosing shortens INR stabilization by 40%.(5)Lifestyle Interventions:Combined Mediterranean diet and moderate exercise reduce AF burden(HR=0.69)and reverse left atrial enlargement(LAVI reduced by 12%).(6)Multidisciplinary Care:Integrated“heart-brain team”approaches combining LAAC and PFO closure lower annual stroke recurrence from 8.2%to 2.1%,while comprehensive rehabilitation improves functional capacity(6MWD+45 m)and quality of life(SF-36+12 points).Conclusion:NVAF management has evolved from isolated anticoagulation to a multidimensional paradigm integrating genomics,AI,and lifestyle modification.Future priorities include validating long-term outcomes of novel therapies,addressing evidence gaps in special populations,and implementing digitally enabled,cross-disciplinary care models to mitigate the global burden of NVAF-related complications.
基金This study was supported by the National Natural Science Foundation project （No.81670364） and Natural Science Foundation of Guangdong Province （No. 2016A030313356）.
文摘Background：Metabolic syndrome （MS） is a risk factor for stroke and thromboembolism event.Left atrial or LA appendage （LA/LAA） thrombus is a surrogate of potential stroke.The relationship between MS and atrial thrombus remains unclear.In this study,we sought to investigate the effect of MS on risk stratification of LA/LAA thrombus formation in patients with nonvalvular atrial fibrillation （NVAF）.Methods：This cross-sectional study enrolled 294 consecutive NVAF patients without prior anticoagulant and lipid-lowering therapies.LA/LAA thrombus was determined by transesophageal echocardiography.Risk assessment of LA/LAA thrombus was performed using the CHADS2,CHA2DS2-VASc,MS,CHADS2-MS,and CHA2DS2-VASc-MS scores.Logistic regression analyses were performed to determine which factors were significantly related to LA/LAA thrombus.Odds ratio （OR） including 95% confidence interval was also calculated.The predictive powers of different scores for the risk of LA/LAA thrombus were represented by C-statistics and compared by receiver operating characteristic （ROC） analysis.Results：LA/LAA thrombi were identified in 56 patients （19.0%）.Logistic analysis showed that MS was the strongest risk factor for LA/LAA thrombus in NVAF patients （OR =14.698,P 〈 0.001）.ROC curve analyses revealed that the C-statistics of CHADS2-MS and CHA2DS2-VASc-MS was significantly higher than those of CHADS2 and CHA2DS2-VASc scores （CHADS2-MS vs.CHADS2,0.807 vs.0.726,P=0.0019）.Furthermore,MS was helpful for identifying individuals with a high risk of LA/LAA thrombus in the population with a low risk of stroke （CHADS2 or CHA2DS2-VASc score =0）.Conclusions：MS is associated with LA/LAA thrombus risk in patients with NVAF.In addition to the CHADS2 and CHA2DS2-VASc scores,the CHADS2-MS and CHA2DS2-VASc-MS scores provide additional information on stroke risk assessment.
基金supported by grants from the Beijing Municipal Administration of Hospitals Clinical Medicine Developme of Special Funding Support(No.ZY201302)The Min stry of S&T Program of Chinese Arrhythmia Registrion Study(No.2013BAI09B02)the International S Cooperation Program of China(No.2013DFB36540).
文摘Background:Warfarin is the most common oral anticoagulant to decrease the stroke risk associated with atrial fibrillation(AF).There are very few prospective studies that have explored whether warfarin has an association with damage on renal function in Chinese patients with nonvalvular AF(NVAF).The aim of this study was to evaluate the effects of warfarin on renal function and study the factors associated with kidney dysfunction in Chinese adult NVAF patients without dialysis therapy.Methods:From January 2011 to December 2013,a total of 951 NVAF patients from 18 hospitals were enrolled.The estimated glomerular filtration rate(eGFR)was calculated from baseline and fbllow-up serum creatinine levels.Kaplan-Meier survival curves compared the survival of a〉25%decline in eGFR(hereafter,endpoint)~while Cox models estimated hazard ratios(HRs)and 95%confidence intervals for this event after adjustment for age,gender,and selected potential risk factors for renal dysfunction.Cox regression analysis of the various clinical potential variables was performed to identify the predictors of a-〉25%decline in eGFR.Results:After a 58-month follow-up,951 NVAF patients were divided by observation into warfarin(n=655)and no anticoagulation groups(n=296)and 120(12.6%)patients experienced renal endpoint.Kaplan-Meier survival curves showed that the survival period was not different in the two groups(χ2=0.178,log-rank P=0.67),but patients with systolic blood pressure(SBP)〈140 mmHg have significant difference with patients with SBP≥140 mmHg(χ2=4.903,log-rank P=0.03).Multivariate Cox regression analysis revealed baseline eGFR and SBP as independent predictors of the endpoint,with HRs of 1.00,and 1.02,respectively.Conclusion:In patients with NVAF,eGFR and SBP are associated with the deterioration of kidney function while Warfarin is not the risk factor of the≥25%decline in eGFR.
