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Echocardiographic predictors of de novo atrial fibrillation and clinical outcomes in post-acute myocardial infarction heart failure

2026-09-25T10:09:26Z

Title: Echocardiographic predictors of de novo atrial fibrillation and clinical outcomes in post-acute myocardial infarction heart failure Authors: Doina, V.; Chiriliuc, Nadejda; Bursacovschi, Daniela; Vetrilă, S.; David, Lilia Abstract: Abstract Background Despite advances in reperfusion strategies, acute myocardial infarction (AMI) remains a major cause of heart failure. De novo atrial fibrillation (NOAF) occurring in the setting of AMI can be associated with adverse outcomes. Early identification of patients at risk for NOAF remains a clinical challenge. The predictive value of echocardiographic parameters for NOAF in AMI–related heart failure is not fully established. Purpose To identify echocardiographic predictors of NOAF after AMI and assess its prognostic impact on heart failure and cardiovascular outcomes. Methods A prospective study included 150 adults with AMI, who were classified according to the occurrence of NOAF (75 pts) during hospitalization or maintenance of sinus rhythm (75 pts). Patients with previous atrial fibrillation, severe non-cardiac comorbidities, cognitive impairment, or substance abuse were excluded. All participants underwent standardized clinical, laboratory, and echocardiographic evaluation. At the 2-year follow-up, patients were assessed for hospitalization for heart failure, all-cause mortality, cardiovascular mortality, stroke, and major bleeding events. Results In the initial structural echocardiographic assessment, the only parameters significantly associated with NOAF were absolute left atrial volume (59.8 ml vs. 51.2 ml; p < 0.001) and indexed volume (32.9 ml/m² vs. 26.7 ml/m²; p < 0.001), as well as a significant increase in left ventricular end-diastolic diameter (58.6 mm vs. 53.5 mm; p = 0.015). LVEF was lower in the NOAF group—44.0% (95% CI: 20–63) versus 54.0% (95% CI: 28–70) in sinus rhythm, Mann–Whitney test 2059, p = 0.005. HFmrEF was present in 42.7% of NOAF patients (95% CI: 35–51%) versus 38.7% in sinus rhythm (95% CI: 28–50%). HFrEF was observed in 16.0% of NOAF patients (95% CI: 7.7–24%) compared with 1.3% (95% CI: 0–3.9%) in sinus rhythm. LV S’ velocity, was significantly lower in NOAF (median 9.8 cm/s, 95% CI: 4.5–12.0) than in sinus rhythm (10.5 cm/s, 95% CI: 5.6–14.3), Mann–Whitney test 2079, p = 0.006. Right ventricular function was also affected: TAPSE was reduced in NOAF (median 19.0 mm, 95% CI: 15–32) versus 21.0 mm (95% CI: 16–43) in sinus rhythm, Mann–Whitney test 2228, p = 0.026. RV longitudinal systolic velocity S’ was lower in NOAF (median 12.0 cm/s, 95% CI: 7.8–18.0) compared with sinus rhythm (12.5 cm/s, 95% CI: 10.2–18.0), Mann–Whitney test 1900, p < 0.001. At 2-year follow-up, patients with NOAF had higher cardiovascular mortality (18.7% vs. 6.7; p = 0.018) and more frequent hospitalizations for heart failure (37.3% vs. 20.0%; p = 0.030) compared with those in sinus rhythm. Conclusion Overall, NOAF identifies a heart failure–prone phenotype in which left atrial enlargement emerges as the key structural predictor, accompanied by biventricular systolic impairment and translating into increased cardiovascular mortality and heart failure hospitalizations at 2 years.

Diastolic impairment drives new-onset atrial fibrillation during acute myocardial infarction

2026-09-25T10:07:31Z

Title: Diastolic impairment drives new-onset atrial fibrillation during acute myocardial infarction Authors: Badan, Maxim; Chiriliuc, Nadejda; David, Lilia; Bursacovschi, Daniela Abstract: Abstract Introduction Recent studies underscore that new-onset atrial fibrillation (NOAF) in acute myocardial infarction (AMI) remains a clinically relevant issue. Contemporary registries show that patients who develop NOAF frequently display markers of elevated filling pressures. However, evidence is far from uniform: while several analyses support diastolic impairment as a central mechanism, others report only modest associations. Purpose The study aimed to assess the link between diastolic dysfunction and new-onset atrial fibrillation during acute myocardial infarction. Methods This prospective study included 150 adults with AMI. Patients were randomly assigned to two groups: those who developed NOAF in the acute phase and those who maintained sinus rhythm. Individuals with prior atrial fibrillation, major non-cardiac comorbidities limiting life expectancy, cognitive impairment, or substance abuse were excluded. All participants underwent standardized clinical, laboratory, and echocardiographic assessment. Results A total of 150 individuals were enrolled, with a mean age of 67.4 ± 10.6 years (95% CI: 66–69). Sex distribution was comparable between the two groups, with no statistically significant difference observed (p = 0.12). In the total cohort, STEMI was the dominant presentation, identified in 104 patients (69.3%; 95% CI: 62–77%), whereas non-STEMI accounted for 46 cases (30.7%; 95% CI: 23–38%). Cardiogenic shock was documented in 10 patients overall (6.7%; 95% CI: 2.7–11%), and all these events occurred exclusively in the NOAF group (10/751; 13.3%; 95% CI: 5.6–21%). Analysis of diastolic parameters revealed a markedly impaired diastolic profile in patients who developed new-onset atrial fibrillation during acute myocardial infarction. Left atrial volume index ≥34 mL/m² was more frequent in the NOAF group (44.0% vs. 14.7%; p < 0.001). Early filling velocity (E) was similar between groups, whereas A-wave velocity showed a significant reduction in NOAF patients (p = 0.001), resulting in a higher E/A ratio (median 1.4 vs. 1.0; p = 0.007). Additional markers of elevated filling pressures were consistently worse in the NOAF group. Vp was significantly reduced (61.3 ± 26.1 mm/s vs. 75.3 ± 20.0 mm/s; p < 0.001), and the E/Vp ratio was significantly higher (1.2 ± 0.5 vs. 0.9 ± 0.4; p = 0.002), with E/Vp ≥1.5 present in 38.7% of NOAF patients (p < 0.001). Global grading of diastolic dysfunction demonstrated a significant shift toward more advanced dysfunction in the NOAF group (p = 0.004): grade III dysfunction was present in 21.3% of NOAF patients versus 13.3% in those maintaining sinus rhythm. Markers of increased right-sided pressure, including higher TR velocity (p = 0.025) and reduced IVC respiratory variation (p < 0.001). Conclusions In this AMI cohort, patients with NOAF showed larger atria, impaired relaxation, and higher filling pressures, indicating diastolic dysfunction as a key substrate predisposing to NOAF during acute ischemia.

Fibrilația atrială de novo în infarctul miocardic acut – între marker de severitate și complicație evolutivă

2026-09-24T10:20:23Z

Title: Fibrilația atrială de novo în infarctul miocardic acut – între marker de severitate și complicație evolutivă Authors: Chiriliuc, Nadejda; Bursacovschi, Daniela; Eșanu, Ion; David, Lilia Abstract: Rezumat. Introducere: Fibrilația atrială de novo (FA de novo) este o complicație frecventă a infarctului miocardic acut (IMA) și poate reflecta atât severitatea leziunii ischemice, cât și instabilitatea hemodinamică. Înțelegerea caracteristicilor clinicoangiografice asociate FA de novo poate ghida evaluarea prognosticului și managementul terapeutic al pacienților cu IMA. Scop: Evaluarea comparativă a profilului angiografic, severității clinice și particularităților evolutive ale IMA la pacienții cu și fără FA de novo. Materiale și metode: Studiul a fost observațional, comparativ, desfășurat în IMSP Institutul de Cardiologie. Au fost incluși pacienți cu IMA confirmat conform ghidului Societății Europene de Cardiologie (ESC) 2014, cu debut ≤24 ore, supuși angiocoronarografiei și revascularizării prin angioplastie coronariană cu implantare de stent. Pacienții au fost împărțiți în două grupuri: cu FA de novo și fără FA. Au fost colectate date demografice, clinice și angiografice, inclusiv tipul și localizarea IMA, scorul SYNTAX, revascularizare și complicațiile acute. Analiza statistică a inclus testele χ², Fisher, Mann–Whitney și t-Student, cu prag de semnificație p < 0.05. Rezultate: Distribuția STEMI/non-STEMI a fost similară între grupuri (54 [74.7%] pacienți fără FA vs. 48 [64.0%] cu FA de novo, p = 0.2). IMA tip 1 a predominat în ambele grupuri (97.3% FA de novo vs. 98.7% fără FA, p = 0.5). Șocul cardiogen a fost semnificativ mai frecvent în FA de novo (10 [13.3%], p = 0.001). Artera descendentă anterioară a fost mai frecvent implicată la pacienții fără FA (52.0% vs. 34.7%), iar artera circumflexă mai des în grupul cu FA de novo (22.7%). Scorul SYNTAX a fost mai mare în FA de novo (mediana 29.0 vs. 27.0, p = 0.046). Timpul până la reperfuzie a fost mai frecvent întârziat (>6 ore: 17.3% vs. 12.0%) și revascularizarea completă a fost urmărită în proporție mai redusă în grupul cu FA de novo (45.3% vs. 73.3%). Concluzie: FA de novo în IMA se asociază cu o boală coronariană mai extinsă și complexă, instabilitate hemodinamică și reperfuzie miocardică mai tardivă. FA de novo reprezintă atât un marker al severității infarctului, cât și o complicație evolutivă cu implicații prognostice semnificative, justificând monitorizare și management individualizat.; Summary. Introduction: New-onset atrial fibrillation (NOAF) is a common complication of acute myocardial infarction (AMI) and may reflect both the severity of ischemic injury and hemodynamic instability. Understanding the clinico-angiographic characteristics associated with NOAF can guide prognosis assessment and therapeutic management in patients with AMI. Objective: To comparatively evaluate the angiographic profile, clinical severity, and evolution of acute myocardial infarction in patients with and without new-onset atrial fibrillation. Materials and Methods: This was an observational, comparative study conducted at the Institute of Cardiology. Patients with AMI confirmed according to the ESC 2014 guidelines, with symptom onset ≤24 hours, who underwent coronary angiography and myocardial revascularization with stent implantation, were included. Patients were divided into two groups: with NOAF and in sinus rhythm. Demographic, clinical, and angiographic data were collected, including infarct type, localization, SYNTAX score, acute complications, and revascularization parameters. Statistical analysis included χ², Fisher’s exact test, Mann–Whitney, and Student’s t-test, with significance set at p < 0.05. Results: The distribution of STEMI/non-STEMI was similar between groups (54 [74.7%] patients without AF vs. 48 [64.0%] with NOAF, p = 0.2). Type 1 infarct predominated in both groups (97.3% NOAF vs. 98.7% sinus rhythm, p = 0.5). Cardiogenic shock occurred significantly more frequently in NOAF (10 [13.3%], p = 0.001). The left anterior descending artery was more often involved in patients without AF (52.0% vs. 34.7%), while the circumflex artery was more frequently involved in NOAF (22.7%). The SYNTAX score was higher in NOAF (median 29.0 vs. 27.0, p = 0.046). Complete revascularization was less frequent in NOAF (45.3% vs. 73.3%), with delayed reperfusion (>6 hours) more common (17.3% vs. 12.0%). Conclusion: New-onset atrial fibrillation in AMI is associated with more extensive and complex coronary artery disease, hemodynamic instability, and delayed access to reperfusion. NOAF represents both a marker of infarct severity and an evolving complication with important prognostic implications, warranting individualized monitoring and management.; Резюме. Введение: Впервые выявленная фибрилляция предсердий (ФП) является частым осложнением острого инфаркта миокарда (ОИМ) и может отражать как тяжесть ишемического поражения, так и гемодинамическую нестабильность. Изучение клинико-ангиографических характеристик, связанных с впервые выявленной ФП, может помочь в оценке прогноза и выборе терапевтической стратегии у пациентов с ОИМ. Цель: Сравнительная оценка ангиографического профиля, клинической тяжести и особенностей течения острого инфаркта миокарда у пациентов с впервые выявленной ФП и без нее. Материалы и методы: Исследование носило наблюдательный, сравнительный характер и проводилось в ГОУ «Институт Кардиологии». Включались пациенты с ОИМ, подтвержденным согласно рекомендациям ESC 2014, с дебютом симптомов ≤24 часов, которым выполнялась ангиокоронарография и миокардиальная реваскуляризация с установкой стента. Пациенты были разделены на две группы: с впервые выявленной ФП и в синусовом ритме. Собирались демографические данные, клинические и ангиографические, включая тип инфаркта, локализация, оценка по шкале SYNTAX, острые осложнения и параметры реваскуляризации. Статистический анализ включал тесты χ², Фишера, Манна–Уитни и t-критерий Стьюдента с уровнем значимости p < 0,05. Результаты: Распределение STEMI/non-STEMI было схожим в обеих группах (54 [74,7%] пациентов без ФП против 48 [64,0%] с впервые выявленной ФП, p = 0,2). Инфаркт 1 типа преобладал в обеих группах (97,3% впервые выявленная ФП против 98,7% в синусовом ритме, p = 0,5). Кардиогенный шок был значительно чаще у пациентов с впервые выявленной ФП (10 [13,3%], p = 0,001). Передняя нисходящая артерия чаще поражалась у пациентов без ФП (52,0% против 34,7%), а огибающая артерия – чаще у пациентов с впервые выявленной ФП (22,7%). Шкала SYNTAX была выше в группе впервые выявленной ФП (медиана 29,0 против 27,0, p = 0,046). Полная реваскуляризация встречалась реже у пациентов с впервые выявленной ФП (45,3% против 73,3%), при этом более часто наблюдалась поздняя реперфузия (>6 часов: 17,3% против 12,0%). Выводы: Впервые выявленная ФП при ОИМ ассоциируется с более обширным и сложным поражением коронарных артерий, гемодинамической нестабильностью и более поздним доступом к реперфузии. Впервые выявленная ФП выступает как маркер тяжести инфаркта, так и как осложнение течения с важными прогностическими последствиями, требующими индивидуализированного мониторинга и управления.

Mecanisme inflamatorii și susceptibilitatea atrială în fibrilația atrială de novo după infarctul miocardic acut

2026-09-24T10:01:41Z

Title: Mecanisme inflamatorii și susceptibilitatea atrială în fibrilația atrială de novo după infarctul miocardic acut Authors: Chiriliuc, Nadejda; Bursacovschi, Daniela; Eșanu, Ion; David, Lilia Abstract: Summary. Introduction: New-onset atrial fibrillation (NOAF) represents a frequent and prognostically significant complication of acute myocardial infarction (AMI), reflecting both the severity of ischemic injury and hemodynamic instability. Systemic inflammation and structural remodeling of the LA appear to play a key role in triggering and maintaining the arrhythmia. Objective: To evaluate the association between systemic inflammatory parameters and atrial structural characteristics, as well as their impact on the occurrence of new-onset AF in the context of AMI. Materials and Methods: This observational study included 150 AMI patients admitted to the Institute of Cardiology between 2019 and 2022, with symptom onset ≤24 hours, undergoing coronary angiography and percutaneous coronary intervention with stent placement. Participants were divided into two equal groups: Group I – patients with NOAF (n=75) and Group II – patients who maintained sinus rhythm (n=75). Inflammatory assessment included total leukocytes, neutrophil fraction, neutrophil-to-lymphocyte ratio (NLR), high-sensitivity C-reactive protein (hs-CRP), and oxidative stress markers – superoxide dismutase (SOD) and malondialdehyde (MDA). Atrial remodeling was assessed echocardiographically according to the 2015 EACVI/ASE guidelines, measuring left atrial (LA) volume, LA volume indexed to body surface area (LA/BSA), right atrial (RA) volume, RA/BSA, and RA area. Statistical analyses included χ², Fisher’s exact test, Mann–Whitney U, and Student’s t-test, with a significance threshold of p < 0.05. Results: The distribution of STEMI/non-STEMI and AMI types was similar between groups. Cardiogenic shock occurred more frequently in new-onset AF (13.3% vs. 0%, p = 0.001). Median LA volume was higher in NOAF: LA 59.8 ml (95% CI: 57–62) vs. 51.2 ml (95% CI: 49–53); LA/BSA 32.9 ml/m² (95% CI: 31–34) vs. 26.7 ml/m² (95% CI: 25–28); proportion of patients with LA/BSA ≥ 34 ml/m²: 44.0% vs. 14.7%, p < 0.001. RA volume and area were comparable between groups. Systemic inflammation was more pronounced in NOAF: NLR 3.7 (95% CI: 3.7–4.6) vs. 2.6 (95% CI: 2.5–2.9), p< 0.001; hs-CRP 2.8 mg/L (95% CI: 2.8–4.0) vs. 2.2 mg/L (95% CI: 2.2–3.0), p = 0.05. Oxidative stress markers were significantly higher: SOD 1,976 U/L vs. 1,342 U/L, p < 0.001; MDA 1.9 µmol/L vs. 0.7 µmol/L, p < 0.001. Conclusion: NOAF in AMI is associated with increased systemic inflammation and significant LA structural remodeling, suggesting that inflammation and atrial dilation constitute complementary mechanisms involved in the initiation and maintenance of the arrhythmia. These factors reflect both the severity of ischemic injury and the structural and biological substrate of AF, emphasizing the need for individualized monitoring and management.; Rezumat. Introducere: Fibrilația atrială (FA) de novo reprezintă o complicație frecventă și cu prognostic nefavorabil a infarctului miocardic acut (IMA), reflectând atât severitatea leziunii ischemice, cât și instabilitatea hemodinamică. Inflamația sistemică și remodelarea structurală a atriului stâng (AS) par să joace un rol esențial în declanșarea și întreținerea aritmiei. Scop: Evaluarea asociării dintre parametrii inflamatori sistemici și caracteristicile structurale atriale, precum și impactul acestora asupra apariției FA de novo în cadrul IMA. Materiale și metode: Studiul observațional a inclus 150 de pacienți cu IMA internati în IMSP Institutul de Cardiologie în perioada 2019–2022, cu debut ≤24 ore, supuși angiocoronarografiei și revascularizării prin angioplastie coronariană cu stent. Participanții au fost împărțiți în două grupuri: lotul I – pacienți cu FA de novo (n=75) și lotul II – pacienți fara fA (n=75). Evaluarea inflamatorie a inclus leucocitele totale, fracțiunea neutrofilică, raportul neutrofile/limfocite (NLR), proteina C reactivă ultrasensibilă (hs-CRP) și markeri ai stresului oxidativ (SO) – superoxid dismutaza (SOD) și dialdehida malonică (MDA). Remodelarea atrială a fost evaluată ecocardiografic (EcoCG) conform ghidurilor EACVI/ ASE 2015, prin evaluarea volumului atriului stâng (AS), volumul AS indexat la suprafața corporală (AS/SC), volumul atriului drept (AD), AD/SC și aria AD. Analizele statistice au utilizat testul χ², Fisher, Mann–Whitney și t-Student, cu prag de semnificație p < 0.05. Rezultate: Distribuția STEMI/non-STEMI și a tipurilor de IMA a fost similară între grupuri. Șocul cardiogen a fost mai frecvent în FA de novo (13.3% vs. 0%, p = 0.001). Volumul AS median a fost mai mare în FA de novo: AS 59.8 ml (IÎ 95%: 57–62) vs. 51.2 ml (IÎ 95%: 49–53); AS/SC a constituit 32.9 ml/m² (IÎ 95%: 31–34) vs. 26.7 ml/m² (IÎ 95%: 25–28); la fel ca și proporția pacienților cu AS/SC ≥ 34 ml/m²: 44.0% vs. 14.7%, p < 0.001. Volumul și aria AD au fost comparabile între grupuri. Inflamația sistemică a fost mai accentuată în FA de novo: NLR 3.7 (IÎ 95%: 3.7–4.6) vs. 2.6 (IÎ 95%: 2.5–2.9), p < 0.001; hs-CRP 2.8 mg/L (IÎ 95%: 2.8–4.0) vs. 2.2 mg/L (IÎ 95%: 2.2–3.0), p = 0.05. Markerii SO au fost semnificativ mai ridicați la pacienții cu FA de novo: SOD 1,976 U/L vs. 1,342 U/L, p < 0.001; MDA 1.9 µmol/L vs. 0.7 µmol/L, p < 0.001. Concluzie: FA de novo în IMA se asociază cu un nivel sporit al inflamației sistemice și remodelare structurală semnificativă a AS, sugerând că inflamația și dilatarea atrială constituie mecanisme complementare implicate în debutul și întreținerea aritmiei. Acești factori indică atât severitatea leziunii ischemice, cât și substratul structural și biologic al FA, subliniind necesitatea monitorizării și managementului individualizat.; Резюме. Введение: Впервые выявленная ФП является частым и прогности.чески значимым осложнением острого инфаркта миокарда (ОИМ), отражающим как тяжесть ишемического повреждения, так и гемодинамическую нестабильность. Системное воспаление и структурная ремоделирование левого предсердия (ЛП) играют ключевую роль в возникновении и поддержании аритмии. Цель: Оценить связь между системными воспалительными параметрами и структурными характеристиками предсердий, а также их влияние на развитие впервые выявленной ФП при ОИМ. Материалы и методы: В обсервационное исследование было включено 150 пациентов с ОИМ, госпитализированных в ГОУ Институт Кардиологии в период 2019–2022 гг., с временем от начала симптомов ≤24 ч, которым проводилась коронарная ангиография и чрескожное коронарное вмешательство со стентированием. Участников разделили на две равные группы: группа I – пациенты с впервые выявленной ФП (n=75) и группа II – пациенты, сохранявшие синусовый ритм (n=75). Воспалительная оценка включала общий лейкоцитоз, долю нейтрофилов, отношение нейтрофил/лимфоцит (NLR), высокочувствительный С-реактивный белок (hsCRP), а также маркеры окислительного стресса – супероксиддисмутазу (SOD) и малоновый диальдегид (MDA). Ремоделирование предсердий оценивали эхокардиографически согласно рекомендациям EACVI/ASE 2015, измеряя объем ЛП, индексированный к площади поверхности тела (ЛП/BSA), объем правого предсердия (ПП), ПП/BSA и площадь ПП. Статистическая обработка включала χ², тест Фишера, тест Манна–Уитни и t-критерий Стьюдента, с порогом значимости p < 0,05. Результаты: Распределение STEMI/non-STEMI и типов ОИМ было сходным в группах. Кардиогенный шок встречался чаще при впервые выявленной ФП (13,3% против 0%, p = 0,001). Медианный объем ЛП был выше при впервые выявленной ФП: ЛП 59,8 мл (95% ДИ: 57–62) против 51,2 мл (95% ДИ: 49–53); ЛП/BSA 32,9 мл/ м² (95% ДИ: 31–34) против 26,7 мл/м² (95% ДИ: 25–28); доля пациентов с ЛП/BSA ≥ 34 мл/м²: 44,0% против 14,7%, p < 0,001. Объем и площадь ПП были сопоставимы между группами. Системное воспаление было более выражено при впервые выявленной ФП: NLR 3,7 (95% ДИ: 3,7–4,6) против 2,6 (95% ДИ: 2,5–2,9), p < 0,001; hsCRP 2,8 мг/л (95% ДИ: 2,8–4,0) против 2,2 мг/л (95% ДИ: 2,2–3,0), p = 0,05. Маркеры окислительного стресса были значительно выше у пациентов с впервые выявленной ФП: SOD 1 976 Е/л против 1 342 Е/л, p < 0,001; MDA 1,9 мкмоль/л против 0,7 мкмоль/л, p < 0,001. Заключение: Впервые выявленная ФП при ОИМ связана с повышенным системным воспалением и значительным структурным ремоделированием ЛП, что указывает на то, что воспаление и дилатация предсердия являются взаимодополняющими механизмами, участвующими в возникновении и поддержании аритмии. Эти факторы отражают как тяжесть ишемического поражения, так и структурный и биологический субстрат ФП, подчеркивая необходимость индивидуального мониторинга и ведения пациентов.