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Incident atrial fibrillation in systemic sclerosis: the predictive role of B-type natriuretic peptide
Ilias Giallafos1, Filippos Triposkiadis, Evangelos Oikonomou
1First Cardiac Department, University of Athens, Athens, University of Athens, Athens, Greece.
Insights
Systemic sclerosis (SSc) patients have a high incidence of atrial fibrillation (AF). Elevated B-type natriuretic peptide (BNP) levels are the sole independent predictor of AF in this population, aiding risk stratification.
Area of Science:
- Cardiology
- Rheumatology
- Internal Medicine
Background:
- Atrial fibrillation (AF) is a frequent complication in systemic sclerosis (SSc).
- AF in SSc patients is linked to increased morbidity, mortality, and healthcare costs.
Purpose of the Study:
- To prospectively investigate the incidence of AF in SSc patients.
- To identify independent predictors of new-onset AF in this cohort.
Main Methods:
- 49 SSc patients and 21 controls underwent baseline evaluations including blood tests, ECG, echocardiography, and 24-hour Holter monitoring.
- Follow-up included repeat Holter monitoring every 6 months for a mean of 72 months.
Main Results:
- 36.7% of SSc patients developed AF during follow-up.
- Baseline differences in SSc-AF vs. SSc-SR vs. controls included left ventricular mass, mitral E velocity, left atrial volume, and logBNP.
- Cox analysis identified B-type natriuretic peptide (BNP) as the only independent predictor of incident AF.
Conclusions:
- Incident AF is common in SSc, particularly with left ventricular diastolic dysfunction, left atrial overload, and elevated BNP.
- BNP is a key independent predictor and should be used for risk stratification in SSc patients.
- Early identification and management of AF risk factors in SSc are crucial.
Introduction:
Atrial fibrillation (AF) is common in patients with systemic sclerosis (SSc) and is associated with significant morbidity, mortality, and healthcare expenditures. The aim of this study was to prospectively determine the incidence and the independent predictors of AF in this patient population.
Methods:
Forty-nine patients (age 50.15 ± 9.25 years, 87.8% female) and 21 healthy controls, all in sinus rhythm, were studied. Evaluation included blood sampling, B-type natriuretic peptide (BNP) measurement, comprehensive electrocardiography and echocardiography at baseline, and 24h ambulatory Holter monitoring at baseline and every 6 months.
Results:
During a mean follow-up of 72 ± 24 months, 18 SSc patients (36.7%) developed AF (SSc-AF group) while 31 remained in sinus rhythm (SSc-SR group); all subjects in the control group (Cl group) remained in SR. Baseline differences between SSc-AF, SSc-SR, and Cl groups included: a) left ventricular (LV) mass: 84.5 ± 26 vs. 71.8 ± 18.6 vs. 60.5 ± 32.6 g/m(2), respectively (p=0.017); b) mitral tissue Doppler imaging E velocity: 14.5 ± 2.8 vs. 17.5 ± 3.4 vs. 20.5 ± 4.4 cm/s (p<0.001); c) left atrial (LA) volume: 18.8 ± 7.8 vs. 13.5 ± 5.1 vs. 9.7 ± 5.4 cm(3)/m(2) (p<0.001); d) LA active emptying volume: 7.6 ± 2.7 vs. 4.7 ± 3.2 vs. 3.3 ± 2.2 cm(3)/m(2) (p<0.001); and e) logBNP: 1.78 ± 0.47 vs. 1.31 ± 0.54 vs. 0.66 ± 0.38 pg/mL (p<0.001). In Cox proportional hazard analysis, BNP was the only independent predictor of incident AF.
Conclusion:
Incident AF was high in SSc, especially in the presence of LV diastolic dysfunction with LA mechanical overload and elevated BNP levels. BNP was the only independent predictor of incident AF; therefore, it should be considered for risk stratification in this population.
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