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A Circulating Biomarker Risk-Prediction Model Correlates with CHADS-2 Risk Score in Chronic Atrial Fibrillation
Smita I Negi1, Ian Greener2, Aashish Anand3
1Section of Cardiology, Medstar Washington Hospital Center/Georgetown University, Washington, DC.
Insights
Inflammation and oxidative stress markers, high-sensitivity C-reactive protein (hs-CRP) and DROMs, correlate with CHADS-2 scores in atrial fibrillation (AF) patients. Combining these biomarkers may improve stroke risk prediction in AF.
Area of Science:
- Cardiology
- Biomarkers
- Atrial Fibrillation Research
Background:
- Inflammation and oxidative stress are implicated in the development and persistence of atrial fibrillation (AF).
- The CHADS-2 scoring system is a validated tool for stratifying stroke risk in AF patients.
Purpose of the Study:
- To investigate the association between markers of oxidative stress and inflammation and CHADS-2 scores in patients with chronic AF.
- To determine if these biomarkers can enhance stroke risk prediction in AF.
Main Methods:
- Calculated CHADS-2 scores for 64 chronic AF patients.
- Measured serum inflammatory markers (hs-CRP, IL-6, IL-1β, TNF-α) and oxidative stress markers (DROMs, IsoPs).
Main Results:
- High-sensitivity C-reactive protein (hs-CRP) and Derivatives of Reactive Oxygen Metabolites (DROMs) showed a positive association with CHADS-2 scores.
- Abnormal hs-CRP and DROMs remained significant predictors of intermediate to severe CHADS-2 risk after adjusting for covariates.
- A combined biomarker risk model using hs-CRP and DROMs demonstrated a strong correlation with CHADS-2 risk categories (r=0.49, p<0.001).
Conclusions:
- A biomarker risk model combining hs-CRP and DROMs effectively correlates with CHADS-2 risk scores in chronic AF.
- These inflammatory and oxidative stress markers hold potential for improving future stroke risk prediction models in AF patients.
Background:
Inflammation and oxidative stress have been linked to the origin and persistence of atrial fibrillation (AF). CHADS-2 scoring system is a risk stratification schema well validated in prognostication of stroke in AF. We evaluated the association of markers of oxidative stress and inflammation with CHADS-2 scores in chronic AF patients.
Methods:
CHADS-2 scores were calculated for 64 subjects with chronic AF. Serum markers of inflammation [C-reactive protein (hs-CRP), interleukin-6 (IL-6), interleukin 1β (IL-1β), tumor necrosis factor-α (TNF-α)] and of oxidative stress [Derivatives of reactive oxygen metabolites (DROMs) and isoprostanes (IsoPs)] were measured.
Results:
Twenty subjects were categorized as 0 (no risk), 24 as 1 (intermediate risk) and 20 as 2 (severe risk) based on their CHADS-2 scores. High sensitivity-CRP (CHADS-2 0=40.0%, 1=70.0%, 2=90.0%; p=0.003) and DROMs (CHADS-2 0=45%, 1=78%, 2=80%; p=0.04) were positively associated with the CHADS-2 risk score. Subjects with intermediate to severe CHADS-2 risk retained significant associations with abnormal hs-CRP (OR: 5.3, 95%CI: 1.1-25.0) and DROMs (adjusted OR: 6.7, 95%CI: 1.2-38.8) after adjusting for gender and hypertension. In a multiple logistic interaction model, there was no significant interaction between hs-CRP and DROMs in their association with CHADS-2 risk categories (p=0.64). A biomarker risk-model, combining hs-CRP and DROMs, correlated well with the CHADS-2 risk categories (r= 0.49, p<0.001).
Conclusions:
A biomarker risk-model using a combination of hs-CRP and DROMs correlates well with CHADS-2 risk scores in chronic AF. Either or both of these markers may add predictive power to future stroke risk prediction models.
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