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Published on: February 26, 2013
Circulating cardiovascular biomarkers in recurrent atrial fibrillation: data from the GISSI-atrial fibrillation trial
R Latini1, S Masson, S Pirelli
1Istituto di Ricerche Farmacologiche "Mario Negri", Milan Istituti Ospitalieri, Cremona POL Madonna della Consolazione, Reggio Calabria, Italy. roberto.latini@marionegri.it
Insights
Elevated levels of certain cardiovascular biomarkers, including high-sensitivity troponin T and N-terminal probrain natriuretic peptide, predict atrial fibrillation recurrence in patients with a history of AF. These findings aid in risk stratification for maintaining sinus rhythm.
Area of Science:
- Cardiology
- Biomarker Discovery
- Atrial Fibrillation Research
Background:
- Predicting long-term sinus rhythm maintenance in atrial fibrillation (AF) patients is challenging.
- Understanding prognostic factors for AF recurrence is crucial for patient management.
Purpose of the Study:
- To evaluate the prognostic significance of circulating cardiovascular biomarkers in patients with a recent history of atrial fibrillation (AF).
- To identify biomarkers that predict the recurrence of AF in patients aiming to maintain sinus rhythm.
Main Methods:
- Plasma concentrations of hs-TnT, NT-proBNP, MR-proANP, MR-proADM, CT-proAVP, and CT-proET-1 were measured in 382 patients from the GISSI-AF study.
- Univariate and multivariate Cox models were used to assess the association between biomarkers, clinical characteristics, and AF recurrence over 12 months.
Main Results:
- Higher baseline concentrations of hs-TnT, MR-proANP, NT-proBNP, and CT-proET-1 independently predicted an increased risk of AF recurrence.
- Patients experiencing AF recurrence showed significantly higher concentrations of most measured biomarkers.
- Changes in MR-proANP levels over time showed a trend towards predicting subsequent AF recurrence.
Conclusions:
- Circulating biomarkers reflecting cardiomyocyte injury/strain and endothelin pathways are associated with AF recurrence.
- These biomarkers may serve as valuable tools for risk stratification in patients with a history of recent AF.
- Further research can explore therapeutic strategies targeting these pathways to prevent AF recurrence.
Objective:
we evaluated the prognostic role of circulating cardiovascular biomarkers in patients with a history of recent atrial fibrillation (AF).
Background:
predicting long-term maintenance of sinus rhythm in patients with AF is difficult.
Methods:
plasma concentrations of three specific cardiac markers [high-sensitivity troponin T (hsTnT), N-terminal probrain natriuretic peptide (NT-proBNP) and mid-regional proatrial natriuretic peptide (MR-proANP)] and three stable fragments of vasoactive peptides [mid-regional proadrenomedullin (MR-proADM), copeptin (CT-proAVP) and CT-proendothelin-1 (CT-proET-1)] were measured at baseline and after 6 and 12 months in 382 patients enrolled in the GISSI-AF study, a prospective randomized trial to determine the effect of valsartan to reduce the recurrence of AF. The association between these markers, clinical characteristics and recurrence of AF was tested by univariate and multivariate Cox models.
Results:
mean patient age was 68 ± 9 years (37.2% females). A total of 84.8% of patients had a history of hypertension. In total, 59.7% qualified for history of AF because of successful cardioversion, 11.8% because of two or more episodes of AF in the 6 months preceding randomization and 28.5% because of both. Patients in AF at 6 or 12 months (203 (53.1%) with first recurrence) had significantly higher concentrations of most biomarkers. Despite low baseline levels, higher concentrations of hsTnT {adjusted hazard ratio (HR) [95% confidence intervals (CIs) for 1 SD increment] (1.15 [1.04-1.28], P = 0.007), MR-proANP (1.15 [1.01-1.30], P = 0.04), NT-proBNP (1.24 [1.11-1.39], P = 0.0001) and CT-proET-1 (1.16 [1.01-1.33], P = 0.03) independently predicted higher risk of a first recurrence of AF. Changes over time of MR-proANP tended to predict subsequent recurrence (adjusted HR [95%CI]) (1.53 [0.98-2.37], P = 0.06).
Conclusion:
circulating markers of cardiomyocyte injury/strain and endothelin are related to recurrence of AF in patients in sinus rhythm with a history of recent AF.
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