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Biomarker-based prediction of sinus rhythm in atrial fibrillation patients: the EAST-AFNET 4 biomolecule study

Larissa Fabritz1,2,3,4,5,6, Christoph Al-Taie1,2,3,6, Katrin Borof2

  • 1University Center of Cardiovascular Science, University Heart and Vascular Center Hamburg, University Medical Center Hamburg Eppendorf, Hamburg, Germany.

European Heart Journal
|August 31, 2024
PubMed

Insights

Low levels of angiopoietin 2 (ANGPT2), bone morphogenetic protein 10 (BMP10), and N-terminal pro-B-type natriuretic peptide (NT-proBNP) predict sinus rhythm in atrial fibrillation patients. Early rhythm control therapy impacts NT-proBNP

Area of Science:

  • Cardiology
  • Biomarker Discovery
  • Atrial Fibrillation Research

Background:

  • Atrial fibrillation (AF) management involves balancing cardiovascular disease processes and rhythm control.
  • Predictors for achieving and maintaining sinus rhythm in AF patients are not well-established.
  • Understanding these predictors is crucial for optimizing AF treatment strategies.

Purpose of the Study:

  • To identify biomarkers that predict sinus rhythm attainment in patients with atrial fibrillation.
  • To investigate the interaction between cardiovascular disease biomarkers and early rhythm control therapy on rhythm outcomes.
  • To validate predictive biomarker findings in longer-term follow-up and external patient cohorts.

Main Methods:

  • Quantified 14 biomarkers related to cardiovascular disease in 1586 AF patients from the EAST-AFNET 4 study.
  • Employed mixed logistic regression models incorporating clinical features to assess biomarker associations with sinus rhythm at 12 months.
  • Validated results at 24 months and in external datasets, analyzing interactions with early rhythm control.

Main Results:

  • Elevated baseline levels of angiopoietin 2 (ANGPT2), bone morphogenetic protein 10 (BMP10), and NT-proBNP were associated with a lower likelihood of sinus rhythm.
  • External validation confirmed that low concentrations of ANGPT2, BMP10, and NT-proBNP predict sinus rhythm.
  • The predictive value of NT-proBNP for sinus rhythm was reduced in patients receiving early rhythm control therapy (Pinteraction = .033).

Conclusions:

  • Low concentrations of ANGPT2, BMP10, and NT-proBNP are reliable indicators for predicting sinus rhythm attainment in AF patients.
  • The predictive power of NT-proBNP is diminished when patients receive early rhythm control interventions.
  • These findings aid in personalizing AF management by identifying patients likely to achieve sinus rhythm.
Abstract

Keywords:
Angiopoietin 2Atrial fibrillationBlood biomarkerBone morphogenetic protein 10Natriuretic peptidesRhythm controlRisk predictionRisk scoreSinus rhythm

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