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Special Issue "Stroke, Dementia and Atrial Fibrillation"

A special issue of Medicina (ISSN 1010-660X).

Deadline for manuscript submissions: 30 September 2019.

Special Issue Editors

Guest Editor
Prof. Dr. Vincenzo Russo

Department of Medical Translational Sciences, University of Campania “Luigi Vanvitelli” – Monaldi Hospital, Via Leonardo Bianchi, 80131 Naples – Italy
Website | E-Mail
Interests: Atrial fibrillation; Cardiovascular pharmacology; arrhythmic disorders; cardiac pacing; non-vitamin K oral anticoagulants; neuromuscular disorders; muscular dystrophies
Guest Editor
Prof. Dr. Riccardo Proietti

Department of Cardiac, Thoracic, and Vascular Sciences – University of Padua, Via Giustiniani 2, 35121 Padua, Italy
Website | E-Mail
Interests: Stroke; cerebrovascular events; silent stroke; dementia; mild cognitive impairment; anticoagulation; non vitamin k oral anticoagulants; atrial fibrillation; cardiac pacing

Special Issue Information

Dear Colleagues,

Stroke and dementia are among the top ten causes of death worldwide as estimated by the World Health Organization. Atrial fibrillation (AF) is estimated to cause of about 15 percent of all ischemic strokes and as many as 30 percent of strokes occurring in people in their 80s. The reduction of burden of stroke related to AF is a difficult goal to achieve because of a few clinical characteristics of AF itself: 1) episodes of arrhythmias may be asymptomatic and misdiagnosed, 2) stroke related to AF tends to be recurrent if an appropriate treatment is not promptly initiated, 3) the occurrence during AF of silent ischemic stroke that may not clinically manifest but may impact cognitive function. Indeed, silent ischemic cerebrovascular events have been recently proposed as the main pathophysiologic mechanisms linking AF with cognitive decline and dementia. 4) Finally, in AF the disjunction between the risks of cerebrovascular events (CVE) and the burden of arrhythmias is held as a dominant concept. Accordingly, the risk of CVE is not directly related to the presence of the arrhythmia but persists even during arrhythmia-free intervals. In other words, the two forms of AF classified according to duration (paroxysmal vs persistent) of arrhythmias hold the same risk of stroke.

Given the complexity of this topic and its impact on clinical practice and public health, Medicina is launching a Special Issue entitled “Stroke, Dementia and Atrial Fibrillation” with the aim of gathering together accurate and up-to-date scientific information on all aspects of association between cerebrovascular events, cognitive impairment and AF. We are pleased to invite you and your co-workers to submit your original research articles reporting on the pathophysiological mechanisms underpinning this association. We also encourage the submission of original manuscripts spanning basic to clinical research and focusing on stroke prevention in AF. We would also like to invite you to submit review articles aimed at providing a comprehensive overview of the recent advances in understanding pharmacological interventions to prevent CVE.

Prof. Dr. Vincenzo Russo
Prof. Dr. Riccardo Proietti
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All papers will be peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Medicina is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 1500 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • Atrial Fibrillation
  • Stroke
  • Cognitive Impairment
  • Dementia
  • Oral anticoagulation
  • Non vitamin K oral anticoagulants
  • Cardiac implanted devices
  • Cardiomyopahty
  • Neuromuscular Disorders

Published Papers (7 papers)

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Research

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Open AccessArticle
Detrimental Impact of Chronic Obstructive Pulmonary Disease in Atrial Fibrillation: New Insights from Umbria Atrial Fibrillation Registry
Medicina 2019, 55(7), 358; https://doi.org/10.3390/medicina55070358
Received: 31 May 2019 / Revised: 25 June 2019 / Accepted: 3 July 2019 / Published: 9 July 2019
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Abstract
Background and objectives: Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. Among extra-pulmonary manifestations of COPD, atrial fibrillation (AF) is commonly observed in clinical practice. The coexistence of COPD and AF significantly affects the risk of cardiovascular [...] Read more.
Background and objectives: Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. Among extra-pulmonary manifestations of COPD, atrial fibrillation (AF) is commonly observed in clinical practice. The coexistence of COPD and AF significantly affects the risk of cardiovascular morbidity and mortality. Nonetheless, the mechanisms explaining the increased risk of vascular events and death associated to the presence of COPD in AF are complex and not completely understood. We analyzed data from an Italian network database to identify markers and mediators of increased vascular risk among subjects with AF and COPD. Materials and Methods: Cross-sectional analysis of the Umbria Atrial Fibrillation (Umbria-FA) Registry, a multicenter, observational, prospective on-going registry of patients with non-valvular AF. Of the 2205 patients actually recruited, 2159 had complete clinical data and were included in the analysis. Results: the proportion of patients with COPD was 15.6%. COPD patients had a larger proportion of permanent AF when compared to the control group (49.1% vs. 34.6%, p < 0.0001) and were more likely to be obese and current smokers. Other cardiovascular risk factors including chronic kidney disease (CKD), peripheral artery disease and subclinical atherosclerosis were more prevalent in COPD patients (all p < 0.0001). COPD was also significantly associated with higher prevalence of previous vascular events and a history of anemia (all p < 0.0001). The thromboembolic and bleeding risk, as reflected by the CHA2DS2VASc and HAS-BLED scores, were higher in patients with COPD. Patients with COPD were also more likely to have left ventricular (LV) hypertrophy at standard ECG than individuals forming the cohort without COPD (p = 0.018). Conclusions: AF patients with COPD have a higher risk of vascular complications than AF patients without this lung disease. Our analysis identified markers and mediators of increased risk that can be easily measured in clinical practice, including LV hypertrophy, CKD, anemia, and atherosclerosis of large arteries. Full article
(This article belongs to the Special Issue Stroke, Dementia and Atrial Fibrillation)
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Open AccessArticle
Physicians’ Perceptions of Their Patients’ Attitude and Knowledge of Long-Term Oral Anticoagulant Therapy in Bulgaria
Medicina 2019, 55(7), 313; https://doi.org/10.3390/medicina55070313
Received: 25 April 2019 / Revised: 17 June 2019 / Accepted: 21 June 2019 / Published: 26 June 2019
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Abstract
Background and Objectives: Oral anticoagulation (OAC) is widely used in daily clinical practice worldwide for various indications. We aimed to explore the perception of Bulgarian clinicians about their patients’ attitude and knowledge of long-term OAC, prescribed for atrial fibrillation (AF) and/or known [...] Read more.
Background and Objectives: Oral anticoagulation (OAC) is widely used in daily clinical practice worldwide for various indications. We aimed to explore the perception of Bulgarian clinicians about their patients’ attitude and knowledge of long-term OAC, prescribed for atrial fibrillation (AF) and/or known deep venous thrombosis (DVT)/pulmonary embolism (PE). Materials and Methods: We performed a cross-sectional study that involved 226 specialists: 187 (82.7%) cardiologists, 23 (10.2%) neurologists, and 16 (7.1%) vascular surgeons. They filled in a questionnaire, specially designed for our study, answering various questions regarding OAC treatment in their daily clinical practice. Results: The mean prescription rate of OACs in AF patients was 80.3% and in DVT/PE—88.6%. One hundred and eighty-seven (82.7%) of the participants stated they see their patients on OAC at least once per month. According to more than one-third of the inquired clinicians, the patients did not understand well enough the provided information concerning net clinical benefit of OAC treatment. About 68% of the clinicians declared that their patients would prefer a “mutual” approach, discussing with the physician the OAC options and taking together the final decision, whereas according to 43 (19.0%), the patients preferred the physician to take a decision for them. Patients’ OAC treatment had been interrupted at least once within the last year due to a physician’s decision by 178 (78.8%) of the participants and the most common reason was elective surgery. The most influential factors for a patient’s choice of OAC were the need of a specific diet to be kept, intake frequency, and possible adverse reactions. Conclusions: Our results suggest that a clinician’s continuous medical education, shared decision-making, and appropriate local strategies for improved awareness of AF/DVT/PE patients are key factors for improvement of OAC management. Full article
(This article belongs to the Special Issue Stroke, Dementia and Atrial Fibrillation)
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Open AccessArticle
Experimental and Computational Studies to Characterize and Evaluate the Therapeutic Effect of Albizia lebbeck (L.) Seeds in Alzheimer’s Disease
Medicina 2019, 55(5), 184; https://doi.org/10.3390/medicina55050184
Received: 27 February 2019 / Revised: 15 May 2019 / Accepted: 16 May 2019 / Published: 21 May 2019
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Abstract
Background and Objectives: Alzheimer’s disease (AD) is a neurodegenerative disorder that deteriorates daily life due to loss of memory and cognitive impairment. It is believed that oxidative stress and cholinergic deficit are the leading causes of AD. Disease-modifying therapies for the treatment [...] Read more.
Background and Objectives: Alzheimer’s disease (AD) is a neurodegenerative disorder that deteriorates daily life due to loss of memory and cognitive impairment. It is believed that oxidative stress and cholinergic deficit are the leading causes of AD. Disease-modifying therapies for the treatment of AD are a challenging task for this century. The search for natural and synthetic agents has attracted the attention of researchers. The objective of this study was a scientific approach to search for most suitable remedy for AD by exploiting the potential of Albizia lebbeck (L.) seeds. Materials and Methods: Hydromethanolic extract of Albizia lebbeck seeds (ALE) was prepared by maceration. The plant was characterized by physico-chemical, phyto-chemical, and high-performance liquid chromatography (HPLC). Thirty-six Wistar albino rats were used in this study and divided into six groups (n = 6). Group I: normal control; Group II: disease control (AlCl3; 100 mg/kg); Group III: standard control (galantamine; 0.5 mg/kg); Groups IV–VI were treated ALE at 100, 200 and 300 mg/kg dose levels, respectively. All the treatments were given orally for 21 consecutive days. Y-maze, T-maze, Morris water maze, hole board, and open field behavioral tests were performed to analyze the cognitive impairment. Biochemical, histological, and computational studies were performed to support the results of behavioral tests. Results: HPLC analysis indicated the presence of quercetin, gallic acid, m-coumaric acid, and sinapic acid. ALE significantly improved the memory and cognitive impairments. Endogenous antioxidant stress biomarker levels and histopathological outcomes supported the therapeutic potential of A. lebbeck in AD. Cholinergic deficits were also ameliorated by ALE co-administration, possibly by the inhibition of hyperactive acetylcholinesterase (AChE). Docking studies supported the potential of ALE against AD. Conclusions: The data suggested that ALE has neuroprotective potential that can be exploited for beneficial effects to treat AD. Full article
(This article belongs to the Special Issue Stroke, Dementia and Atrial Fibrillation)
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Review

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Open AccessReview
Diagnosis and Management of Left Atrium Appendage Thrombosis in Atrial Fibrillation Patients Undergoing Cardioversion
Medicina 2019, 55(9), 511; https://doi.org/10.3390/medicina55090511
Received: 25 June 2019 / Revised: 4 August 2019 / Accepted: 19 August 2019 / Published: 21 August 2019
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Abstract
Atrial fibrillation is the most common cardiac arrhythmia and is associated with an increased risk of stroke and thromboembolic complications. A rhythm control strategy with both electrical and pharmacological cardioversion is recommended for patients with symptomatic atrial fibrillation. Anticoagulant therapy for 3–4 weeks [...] Read more.
Atrial fibrillation is the most common cardiac arrhythmia and is associated with an increased risk of stroke and thromboembolic complications. A rhythm control strategy with both electrical and pharmacological cardioversion is recommended for patients with symptomatic atrial fibrillation. Anticoagulant therapy for 3–4 weeks prior to cardioversion is recommended in order to avoid thromboembolic events deriving from restoring sinus rhythm. Transesophageal echocardiography has a pivotal role in this setting, excluding the presence of left atrial appendage thrombus before cardioversion. The aim of this review is to discuss the epidemiology and risk factors for left atrial appendage thrombosis, the role of echocardiography in the decision making before cardioversion, and the efficacy of different anticoagulant regimens on the detection and treatment of left atrial appendage thrombosis. Full article
(This article belongs to the Special Issue Stroke, Dementia and Atrial Fibrillation)
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Open AccessReview
Subclinical and Asymptomatic Atrial Fibrillation: Current Evidence and Unsolved Questions in Clinical Practice
Medicina 2019, 55(8), 497; https://doi.org/10.3390/medicina55080497
Received: 13 June 2019 / Revised: 6 August 2019 / Accepted: 14 August 2019 / Published: 18 August 2019
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Abstract
Atrial Fibrillation (AF) may be diagnosed due to symptoms, or it may be found as an incidental electrocardiogram (ECG) finding, or by implanted devices recordings in asymptomatic patients. While anticoagulation, according to individual risk profile, has proven definitely beneficial in terms of prognosis, [...] Read more.
Atrial Fibrillation (AF) may be diagnosed due to symptoms, or it may be found as an incidental electrocardiogram (ECG) finding, or by implanted devices recordings in asymptomatic patients. While anticoagulation, according to individual risk profile, has proven definitely beneficial in terms of prognosis, rhythm control strategies only demonstrated consistent benefits in terms of quality of life. In fact, evidence collected by observational data showed significant benefits in terms of mortality, stroke incidence, and prevention of cognitive impairment for patients referred to AF catheter ablation compared to those medically treated, however randomized trials failed to confirm such results. The aims of this review are to summarize current evidence regarding the treatment specifically of subclinical and asymptomatic AF, to discuss potential benefits of rhythm control therapy, and to highlight unclear areas. Full article
(This article belongs to the Special Issue Stroke, Dementia and Atrial Fibrillation)
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Open AccessReview
A Tale of Two Cities”: Anticoagulation Management in Patients with Atrial Fibrillation and Prosthetic Valves in the Era of Direct Oral Anticoagulants
Medicina 2019, 55(8), 437; https://doi.org/10.3390/medicina55080437
Received: 30 June 2019 / Revised: 31 July 2019 / Accepted: 1 August 2019 / Published: 4 August 2019
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Abstract
Valvular heart disease and atrial fibrillation often coexist. Oral vitamin K antagonists have represented the main anticoagulation management for antithrombotic prevention in this setting for decades. Novel direct oral anticoagulants (DOACs) are a new class of drugs and currently, due to their well-established [...] Read more.
Valvular heart disease and atrial fibrillation often coexist. Oral vitamin K antagonists have represented the main anticoagulation management for antithrombotic prevention in this setting for decades. Novel direct oral anticoagulants (DOACs) are a new class of drugs and currently, due to their well-established efficacy and security, they represent the main therapeutic option in non-valvular atrial fibrillation. Some new evidences are exploring the role of DOACs in patients with valvular atrial fibrillation (mechanical and biological prosthetic valves). In this review we explore the data available in the medical literature to establish the actual role of DOACs in patients with valvular heart disease and atrial fibrillation. Full article
(This article belongs to the Special Issue Stroke, Dementia and Atrial Fibrillation)

Other

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Open AccessCase Report
Thromboembolic Events Following Atrial Fibrillation Cardioversion and Ablation: What’s the Culprit?
Medicina 2019, 55(8), 505; https://doi.org/10.3390/medicina55080505
Received: 25 June 2019 / Revised: 13 August 2019 / Accepted: 14 August 2019 / Published: 20 August 2019
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Abstract
Stroke is a rare but possible complication after atrial fibrillation (AF) ablation. However, its etiopathogenesis is far from being completely characterized. Here we report a case of stroke, with recurrent peripheral embolism after AF ablation procedure. In our patient, an in situ femoral [...] Read more.
Stroke is a rare but possible complication after atrial fibrillation (AF) ablation. However, its etiopathogenesis is far from being completely characterized. Here we report a case of stroke, with recurrent peripheral embolism after AF ablation procedure. In our patient, an in situ femoral vein thrombosis and iatrogenic atrial septal defect were simultaneously detected. A comprehensive review of multiple pathophysiological mechanisms of stroke in this context is provided. The case underlines the importance of a global evaluation of patients undergoing AF ablation. Full article
(This article belongs to the Special Issue Stroke, Dementia and Atrial Fibrillation)
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