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Biomarkers in atrial fibrillation: investigating biologic plausibility, cause, and effect
1Duke Cardiovascular Thrombosis Center, Duke Clinical Research Institute, Durham, NC, USA.
Insights
Atrial fibrillation involves inflammation and clotting, but current blood markers poorly predict outcomes or treatment success. Future research into cellular biomarkers may offer better insights for managing this common arrhythmia.
Area of Science:
- Cardiology
- Biomedical Science
Background:
- Atrial fibrillation (AF) is a growing arrhythmia with increasing prevalence.
- AF is characterized by atrial inflammation, fibrosis, remodeling, and thrombosis.
- Peripheral biomarkers indicate heightened thrombin generation, platelet activity, and inflammation in AF.
Purpose of the Study:
- To evaluate the utility of current peripheral biomarkers in atrial fibrillation.
- To explore the predictive value of biomarkers for clinical events and antithrombotic treatment efficacy.
Main Methods:
- Analysis of peripheral circulation biomarkers.
- Correlation assessment between traditional biomarkers and clinical events.
- Evaluation of biomarker ability to predict treatment success.
Main Results:
- Traditional biomarkers reflect AF pathobiology but show weak correlation with clinical events.
- Current biomarkers have limited ability to predict successful cardioembolism prevention with antithrombotics.
Conclusions:
- Peripheral biomarkers currently offer limited clinical utility in predicting AF outcomes.
- Cellular biomarkers are a promising future direction for improving AF diagnosis, prognosis, and management.
Abstract:
Atrial fibrillation, an increasingly common arrhythmia whose prevalence will reach epidemic proportions over the next two decades, is characterized by atrial/atrial appendage inflammation, fibrosis, remodeling, and endocardial thrombosis. Biomarkers measured within the peripheral circulation reflect these pathobiologic events with evidence of heightened thrombin generation and activity, platelet activity, fibrin formation, endocardial injury, inflammatory mediator release, and reduced fibrinolytic potential Unfortunately, the correlation between traditional biomarkers and clinical events is weak at best, as is their ability to predict successful treatment (prevention of cardioembolism) with antithrombotic agents. Future efforts devoted to the investigation of cellular biomarkers will likely provide greater practical yield and insights concerning the development, diagnosis, prognosis, and management of atrial fibrillation.
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