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Velt MJH, Crijns HJGM, van Gelder IC, Linz D, van de Lande ME, Ten Cate H, Spronk HMH, de Melis M, Rienstra M, Mulder BA. Dynamic biomarker profiles in patients with paroxysmal atrial fibrillation: Assessing the differences between sinus rhythm and acute atrial fibrillation episode. Int J Cardiol 2024; 417:132526. [PMID: 39244096 DOI: 10.1016/j.ijcard.2024.132526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Revised: 07/30/2024] [Accepted: 09/04/2024] [Indexed: 09/09/2024]
Abstract
BACKGROUND Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia in adults, yet its underlying pathophysiology remains poorly understood. This study assessed whether circulating biomarker concentrations differ in paroxysmal AF patients during an acute episode compared to sinus rhythm. METHODS The Time of Calamity study is a prospective biomarker study within the RACE V study. Patients underwent venous blood sampling in sinus rhythm at inclusion in RACE V, as well as during a subsequent acute episode of AF for which patients reported to the hospital. Ten biomarkers were analyzed. RESULTS Thirty-nine patients (mean age 60 ± 9 years, 10 (25 %) women) were enrolled. During an acute AF episode, dickkopf-related protein 3 and insulin-like growth factor binding protein 7 were significantly lower, while N-terminal pro B-type natriuretic peptide (NT-proBNP), high-sensitive troponin T (hsTnT), growth differentiation factor 15, and interleukin 6 were significantly higher (all p < 0.05). CONCLUSIONS Biomarker concentrations in paroxysmal AF patients are dynamic and differ between sinus rhythm and acute AF episodes. Notably, NT-proBNP and hsTnT, commonly used in clinical practice, were significantly elevated during an acute AF episode.
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Affiliation(s)
- Marieke J H Velt
- Department of Cardiology, University Medical Center Groningen Thoraxcenter, Groningen, the Netherlands
| | - Harry J G M Crijns
- Department of Cardiology, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| | - Isabelle C van Gelder
- Department of Cardiology, University Medical Center Groningen Thoraxcenter, Groningen, the Netherlands
| | - Dominik Linz
- Department of Cardiology, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands; Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Martijn E van de Lande
- Department of Cardiology, University Medical Center Groningen Thoraxcenter, Groningen, the Netherlands
| | - Hugo Ten Cate
- Department of Cardiology, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands; Departments of Biochemistry and Internal Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Henri M H Spronk
- Department of Cardiology, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands; Departments of Biochemistry and Internal Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Mirko de Melis
- Medtronic Bakken Research Center, Maastricht, the Netherlands
| | - Michiel Rienstra
- Department of Cardiology, University Medical Center Groningen Thoraxcenter, Groningen, the Netherlands
| | - Bart A Mulder
- Department of Cardiology, University Medical Center Groningen Thoraxcenter, Groningen, the Netherlands.
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La Rosa G, Morillo CA, Quintanilla JG, Doltra A, Mont L, Rodríguez-Mañero M, Sarkozy A, Merino JL, Vivas D, Datino T, Calvo D, Pérez-Castellano N, Pérez-Villacastín J, Fauchier L, Lip G, Hatem SN, Jalife J, Sanchis L, Marín F, Filgueiras-Rama D. Practical approach for atrial cardiomyopathy characterization in patients with atrial fibrillation. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2024; 77:656-666. [PMID: 38428580 DOI: 10.1016/j.rec.2024.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 02/16/2024] [Indexed: 03/03/2024]
Abstract
Atrial fibrillation (AF) causes progressive structural and electrical changes in the atria that can be summarized within the general concept of atrial remodeling. In parallel, other clinical characteristics and comorbidities may also affect atrial tissue properties and make the atria susceptible to AF initiation and its long-term persistence. Overall, pathological atrial changes lead to atrial cardiomyopathy with important implications for rhythm control. Although there is general agreement on the role of the atrial substrate for successful rhythm control in AF, the current classification oversimplifies clinical management. The classification uses temporal criteria and does not establish a well-defined strategy to characterize the individual-specific degree of atrial cardiomyopathy. Better characterization of atrial cardiomyopathy may improve the decision-making process on the most appropriate therapeutic option. We review current scientific evidence and propose a practical characterization of the atrial substrate based on 3 evaluation steps starting with a clinical evaluation (step 1), then assess outpatient complementary data (step 2), and finally include information from advanced diagnostic tools (step 3). The information from each of the steps or a combination thereof can be used to classify AF patients in 4 stages of atrial cardiomyopathy, which we also use to estimate the success on effective rhythm control.
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Affiliation(s)
- Giulio La Rosa
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Centro Neurolesi Bonino Pulejo, Messina, Italy
| | - Carlos A Morillo
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Programa Nuevos Mecanismos Arritmogénicos, Madrid, Spain; Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jorge G Quintanilla
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Programa Nuevos Mecanismos Arritmogénicos, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Adelina Doltra
- Institut Clínic Cardiovascular, Hospital Clínic, Barcelona, Spain
| | - Lluis Mont
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Institut Clínic Cardiovascular, Hospital Clínic, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Universitat de Barcelona, Barcelona, Spain
| | - Moisés Rodríguez-Mañero
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Departamento de Cardiología y Unidad Coronaria, Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Complexo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | - Andrea Sarkozy
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
| | - José Luis Merino
- Departamento de Cardiología, Hospital Universitario La Paz, IDIPaz, Universidad Autónoma, Madrid, Spain
| | - David Vivas
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Instituto Cardiovascular, Madrid, Spain
| | - Tomás Datino
- Departamento de Cardiología, Hospitales Universitarios Quirónsalud Pozuelo y Ruber Juan Bravo, Universidad Europea de Madrid, Madrid, Spain
| | - David Calvo
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Instituto Cardiovascular, Madrid, Spain
| | - Nicasio Pérez-Castellano
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Instituto Cardiovascular, Madrid, Spain; Fundación Interhospitalaria para la Investigación Cardiovascular (FIC), Madrid, Spain
| | - Julián Pérez-Villacastín
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Instituto Cardiovascular, Madrid, Spain; Fundación Interhospitalaria para la Investigación Cardiovascular (FIC), Madrid, Spain
| | - Laurent Fauchier
- Centre Hospitalier Régional Universitaire de Tours, Tours, France
| | - Gregory Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
| | - Stéphane N Hatem
- Sorbonne Université, Foundation for Innovation in Cardiometabolism and Nutrition - ICAN, INSERM UMRS 1166, Institute of Cardiology, AP-HP Pitié-Salpêtrière Paris, France
| | - José Jalife
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Programa Nuevos Mecanismos Arritmogénicos, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, United States
| | - Laura Sanchis
- Institut Clínic Cardiovascular, Hospital Clínic, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Universitat de Barcelona, Barcelona, Spain.
| | - Francisco Marín
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Departamento de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, Universidad de Murcia, Instituto Murciano de Investigación Biosanitaria (IMIB-Pascual Parrilla), El Palmar, Murcia, Spain.
| | - David Filgueiras-Rama
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Programa Nuevos Mecanismos Arritmogénicos, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Instituto Cardiovascular, Madrid, Spain.
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Gong KZ, Xu Z, Zhuang TP, Chen XH, Chen JH, Wang WW, Xu WH, Zhang FL. Influence of ABC stroke score on late recurrence of paroxysmal atrial fibrillation following radiofrequency catheter ablation. J Cardiothorac Surg 2024; 19:344. [PMID: 38907311 PMCID: PMC11191333 DOI: 10.1186/s13019-024-02847-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 06/14/2024] [Indexed: 06/23/2024] Open
Abstract
BACKGROUND In this study we investigated the impact of ABC stroke score on the recurrence of paroxysmal atrial fibrillation (PAF) following radiofrequency catheter ablation (RFCA). METHODS A total of 132 patients with PAF who underwent RFCA from October 2018 to September 2019 were included in this study. During the first phase of this study the patients were categorized into two groups based on late recurrence of atrial fibrillation after RFCA. In the second phase, the patients were further divided into two groups based on whether their ABC stroke score was ≥ 6.5. RESULT The univariate analysis indicated that the risk factors for late recurrence of PAF included early recurrence, ABC stroke score, CHA2DS2-VASc score, and NT-proBNP (P < 0.05). Cox multivariate regression analysis revealed that ABC stroke score (P = 0.006) and early recurrence (P = 0.000) were independent predictors of late recurrence, and ABC stroke score ≥ 6.5 was a risk for predicting recurrence of PAF after RFCA with a sensitivity of 66.7% and specificity of 65.7%. After the completion of the 1:1 matching, the univariate Cox analysis indicated that an elevated score of ABC stroke (≥ 6.5) was an independent predictor of late recurrence of PAF (HR = 2.687, 95% CI: 1.036-6.971, P = 0.042). However, using an ABC stroke score cut off at 6.4 predicted the recurrence of atrial tachyarrhythmia with 85% sensitivity and 58.5% specificity. CONCLUSION An ABC stroke score ≥ 6.4 is a predictor for late recurrence of PAF after RFCA.
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Affiliation(s)
- Ke-Zeng Gong
- Department of Cardiology, Fujian Medical University Union Hospital; Fujian Heart Medical Center; Fujian Institute of Coronary Heart Disease; Fujian Clinical Medical Research Center for Heart and Macrovascular Diseases, No.29 Xin-Quan Road, Gulou District, Fuzhou, 350001, Fujian, China
| | - Zhe Xu
- Department of Cardiology, Fujian Medical University Union Hospital; Fujian Heart Medical Center; Fujian Institute of Coronary Heart Disease; Fujian Clinical Medical Research Center for Heart and Macrovascular Diseases, No.29 Xin-Quan Road, Gulou District, Fuzhou, 350001, Fujian, China
| | - Ting-Pei Zhuang
- Department of Cardiology, The First Hospital of Quanzhou, Quanzhou, 362000, Fujian, China
| | - Xue-Hai Chen
- Department of Cardiology, Fujian Medical University Union Hospital; Fujian Heart Medical Center; Fujian Institute of Coronary Heart Disease; Fujian Clinical Medical Research Center for Heart and Macrovascular Diseases, No.29 Xin-Quan Road, Gulou District, Fuzhou, 350001, Fujian, China
| | - Jian-Hua Chen
- Department of Cardiology, Fujian Medical University Union Hospital; Fujian Heart Medical Center; Fujian Institute of Coronary Heart Disease; Fujian Clinical Medical Research Center for Heart and Macrovascular Diseases, No.29 Xin-Quan Road, Gulou District, Fuzhou, 350001, Fujian, China
| | - Wei-Wei Wang
- Department of Cardiology, Fujian Medical University Union Hospital; Fujian Heart Medical Center; Fujian Institute of Coronary Heart Disease; Fujian Clinical Medical Research Center for Heart and Macrovascular Diseases, No.29 Xin-Quan Road, Gulou District, Fuzhou, 350001, Fujian, China
| | - Wen-Hua Xu
- Department of Cardiology, Changji Prefecture People's Hospital in Xinjiang Uygur Autonomous Region, No.303 Yan-an Road, Changji City, 831100, Xinjiang, China.
| | - Fei-Long Zhang
- Department of Cardiology, Fujian Medical University Union Hospital; Fujian Heart Medical Center; Fujian Institute of Coronary Heart Disease; Fujian Clinical Medical Research Center for Heart and Macrovascular Diseases, No.29 Xin-Quan Road, Gulou District, Fuzhou, 350001, Fujian, China.
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4
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Sousa PA, Puga L, Barra S, Campos D, António N, Elvas L, Gonçalves L. High-sensitivity Troponin I and Ablation Effectiveness Quotient after Ablation Index-guided pulmonary vein isolation-markers of arrhythmia recurrence? J Interv Card Electrophysiol 2022; 65:115-121. [PMID: 35469051 DOI: 10.1007/s10840-022-01229-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 04/18/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND There are conflicting data regarding the relationship between high-sensitivity cardiac Troponin I (Hs-cTnI) and the ablation effectiveness quotient (AEQ) with arrhythmia recurrence following atrial fibrillation (AF) ablation. Our goals were to evaluate the impact of the Ablation Index (AI) software on Hs-cTnI and AEQ levels and to assess whether these markers are predictors of arrhythmia recurrence. METHODS Prospective single-center study of 75 consecutive patients referred for paroxysmal AF ablation from October 2017 to January 2019. Procedural endpoints and 2-year outcomes were assessed and compared to those of 75 propensity score-matched patients submitted to non-AI-guided pulmonary vein isolation (PVI) [control group]. RESULTS Compared to the control group, patients having AI-guided PVI had lower Hs-cTnI values (1580 [IQR 1180-2140] ng/L vs. 2600 [IQR 1840 - 3900], p < 0.001) and a lower AEQ (0.9 [IQR 0.6-1.2] ng/L/s vs. 1.4 [0.8-1.6] ng/L/s, p < 0.001). After a median follow-up of 26 (IQR 20-32) months, there was a significant reduction in arrhythmia recurrence in the AI group (15% vs. 31%, HR 0.67 [95% CI, 0.32-1.40], p = 0.02). However, neither Hs-cTnI nor AEQ was predictors of arrhythmia recurrence in AI-guided PVI. CONCLUSIONS The use of the AI software led to reduced levels of Hs-cTnI and lower AEQ in AF patients submitted to PVI. However, none of these markers predicted arrhythmia recurrence.
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Affiliation(s)
- Pedro A Sousa
- Pacing & Electrophysiology Unit, Cardiology Department, Coimbra's Hospital and University Center, Morada: Praceta Prof Mota Pinto, 3000-075, Coimbra, Portugal.
| | - Luís Puga
- Pacing & Electrophysiology Unit, Cardiology Department, Coimbra's Hospital and University Center, Morada: Praceta Prof Mota Pinto, 3000-075, Coimbra, Portugal
| | - Sérgio Barra
- Cardiology Department, Hospital da Luz Arrábida, V. N. Gaia, Portugal
| | - Diana Campos
- Pacing & Electrophysiology Unit, Cardiology Department, Coimbra's Hospital and University Center, Morada: Praceta Prof Mota Pinto, 3000-075, Coimbra, Portugal
| | - Natália António
- Pacing & Electrophysiology Unit, Cardiology Department, Coimbra's Hospital and University Center, Morada: Praceta Prof Mota Pinto, 3000-075, Coimbra, Portugal.,Faculty of Medicine, ICBR, University of Coimbra, Coimbra, Portugal
| | - Luís Elvas
- Pacing & Electrophysiology Unit, Cardiology Department, Coimbra's Hospital and University Center, Morada: Praceta Prof Mota Pinto, 3000-075, Coimbra, Portugal
| | - Lino Gonçalves
- Pacing & Electrophysiology Unit, Cardiology Department, Coimbra's Hospital and University Center, Morada: Praceta Prof Mota Pinto, 3000-075, Coimbra, Portugal.,Faculty of Medicine, ICBR, University of Coimbra, Coimbra, Portugal
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Ocak M, Tascanov MB. Clinical value of the combined use of P-wave dispersion and troponin values to predict atrial fibrillation recurrence in patients with paroxysmal atrial fibrillation. Rev Port Cardiol 2021; 40:679-684. [PMID: 34503707 DOI: 10.1016/j.repce.2020.10.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 10/16/2020] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION P-wave dispersion (PWD) and cardiac troponin levels are independently associated with the recurrence of atrial fibrillation (AF) in patients with paroxysmal AF (PAF). We investigated the clinical usefulness of combining PWD and cardiac troponin I to predict AF recurrence in patients presenting to the emergency department with PAF. METHODS This study included 65 patients with PAF who were divided into three groups according to baseline troponin I and PWD values (group 1, troponin I<0.11 ng/dl and PWD<44.5 ms; group II, troponin I<0.11 ng/dl and PWD≥44.5 ms, or troponin I≥0.11 ng/dl and PWD<44.5 ms; group III, troponin I≥0.11 ng/dl and PWD≥44.5 ms). RESULTS The AF recurrence rate was significantly higher in group III than in groups I and II. Multivariate analysis revealed that the troponin I and PWD values in group III (odds ratio: 7.236, 95% confidence interval: 1.879-27.861, p=0.004) were independent predictors of AF recurrence. CONCLUSIONS The combined use of PWD and basal troponin I levels is a better predictor of AF recurrence than either value alone.
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Affiliation(s)
- Metin Ocak
- Gazı State Hospital, Emergency Clinic Samsun, Turkey.
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Sepehri Shamloo A, Arya A, Darma A, Nedios S, Döring M, Bollmann A, Dagres N, Hindricks G. Atrial fibrillation: is there a role for cardiac troponin? Diagnosis (Berl) 2021; 8:295-303. [PMID: 31913848 DOI: 10.1515/dx-2019-0072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 12/06/2019] [Indexed: 11/15/2022]
Abstract
Atrial fibrillation (AF) is the most common sustained arrhythmia, and its prevalence rate is expected to be doubled over the next decades. Despite the wide use of biomarkers in the management of different cardiac diseases such as myocardial infarction and heart failure, utilization of biomarkers in AF management is not routinely recommended by current guidelines. There is also growing evidence that higher levels of cardiac-specific troponin, as an intracellular protein involved in cardiomyocyte contraction, may be associated with the risk of incident and recurrent AF and its complications. In the present paper, we review the association between troponin and AF and propose clinical suggestions for use of troponin in the management of AF patients.
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Affiliation(s)
- Alireza Sepehri Shamloo
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Arash Arya
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Angeliki Darma
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Sotirios Nedios
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Michael Döring
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Andreas Bollmann
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Nikolaos Dagres
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Gerhard Hindricks
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
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Clinical value of the combined use of P-wave dispersion and troponin values to predict atrial fibrillation recurrence in patients with paroxysmal atrial fibrillation. Rev Port Cardiol 2021. [PMID: 34103233 DOI: 10.1016/j.repc.2020.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION P-wave dispersion (PWD) and cardiac troponin levels are independently associated with the recurrence of atrial fibrillation (AF) in patients with paroxysmal AF (PAF). We investigated the clinical usefulness of combining PWD and cardiac troponin I to predict AF recurrence in patients presenting to the emergency department with PAF. METHODS This study included 65 patients with PAF who were divided into three groups according to baseline troponin I and PWD values (group 1, troponin I<0.11 ng/dl and PWD<44.5 ms; group II, troponin I<0.11 ng/dl and PWD≥44.5 ms, or troponin I≥0.11 ng/dl and PWD<44.5 ms; group III, troponin I≥0.11 ng/dl and PWD≥44.5 ms). RESULTS The AF recurrence rate was significantly higher in group III than in groups I and II. Multivariate analysis revealed that the troponin I and PWD values in group III (odds ratio: 7.236, 95% confidence interval: 1.879-27.861, p=0.004) were independent predictors of AF recurrence. CONCLUSIONS The combined use of PWD and basal troponin I levels is a better predictor of AF recurrence than either value alone.
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8
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High-Sensitivity C-Reactive Protein is a Predictor of Subsequent Atrial High-Rate Episodes in Patients with Pacemakers and Preserved Ejection Fraction. J Clin Med 2020; 9:jcm9113677. [PMID: 33207668 PMCID: PMC7696571 DOI: 10.3390/jcm9113677] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/04/2020] [Accepted: 11/13/2020] [Indexed: 12/16/2022] Open
Abstract
Atrial fibrillation (AF) is associated with morbidity and mortality. Modern pacemakers can detect atrial high-rate episodes (AHREs) as a surrogate for AF. It remains controversial whether inflammation is a cause or a consequence of AF. This study investigated whether the inflammatory biomarker high-sensitivity C-reactive protein (hs-CRP) can predict subsequent AHREs. This study gathered prospective data from patients with pacemakers and a left ventricle EF ≥ 50% between 2015 and 2019. The hs-CRP and other cardiac biomarkers at baseline and device-detected AHREs, defined as atrial rate ≥ 180 bpm and duration ≥ 6 min, were determined. Cox regression analysis was used to estimate the independent predictors for AHREs. A total of 171 consecutive patients were included. During the median follow-up of 614 days, 66 patients (39%) developed subsequent AHREs. In the univariate Cox regression analysis, sick sinus syndrome (p = 0.005), prior AF (p < 0.001), mitral A velocity (p = 0.008), and hs-CRP (p = 0.013) showed significant association with the increased risk of AHREs. In the multivariate Cox regression model, hs-CRP (HR = 1.121, 95% confidence interval = 1.015-1.238, p = 0.024) retained its significance. Our results suggest that elevated hs-CRP could predict subsequent AHREs and that inflammation could play a role in AF pathogenesis in patients with preserved EF.
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9
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Papageorgiou N, Providência R, Falconer D, Wongwarawipat T, Tousoulis D, Lim WY, Chow AW, Schilling RJ, Lambiase PD. Predictive Role of BNP/NT-proBNP in Non-Heart Failure Patients Undergoing Catheter Ablation for Atrial Fibrillation: An Updated Systematic Review. Curr Med Chem 2020; 27:4469-4478. [PMID: 31838987 DOI: 10.2174/0929867326666191213095554] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 11/02/2019] [Accepted: 11/22/2019] [Indexed: 11/22/2022]
Abstract
Atrial Fibrillation (AF) is a growing public health issue, associated with significant morbidity and mortality. In addition to pharmacological therapy, catheter ablation is an effective strategy in restoring and maintaining sinus rhythm. However, ablation is not without risk, and AF recurs in a significant proportion of patients. Non-invasive, easily accessible markers or indices that could stratify patients depending on the likelihood of a successful outcome following ablation would allow us to select the most appropriate patients for the procedure, reducing the AF recurrence rate and exposure to potentially life-threatening risks. There has been much attention paid to Brain Natriuretic Peptide (BNP) and N-Terminal prohormone of Brain Natriuretic Peptide (NT-proBNP) as possible predictive markers of successful ablation. Several studies have demonstrated an association between higher pre-ablation levels of these peptides, and a greater likelihood of AF recurrence. Therefore, there may be a role for measuring brain natriuretic peptides levels when selecting patients for catheter ablation.
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Affiliation(s)
- Nikolaos Papageorgiou
- Electrophysiology Department, Barts Heart Centre, St. Bartholomew's Hospital, West Smithfield, London EC1A 7BE, United Kingdom
| | - Rui Providência
- Electrophysiology Department, Barts Heart Centre, St. Bartholomew's Hospital, West Smithfield, London EC1A 7BE, United Kingdom
| | | | | | - Dimitris Tousoulis
- 1st Cardiology Department, Athens University Medical School, Athens, Greece
| | - Wei Yao Lim
- Electrophysiology Department, Barts Heart Centre, St. Bartholomew's Hospital, West Smithfield, London EC1A 7BE, United Kingdom
| | - Anthony W Chow
- Electrophysiology Department, Barts Heart Centre, St. Bartholomew's Hospital, West Smithfield, London EC1A 7BE, United Kingdom
| | - Richard J Schilling
- Electrophysiology Department, Barts Heart Centre, St. Bartholomew's Hospital, West Smithfield, London EC1A 7BE, United Kingdom
| | - Pier D Lambiase
- Electrophysiology Department, Barts Heart Centre, St. Bartholomew's Hospital, West Smithfield, London EC1A 7BE, United Kingdom
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Kim BS, Kwon CH, Chang H, Kim SH, Kim HJ, Hwang HK, Chung SM. Usefulness of High-Sensitivity Troponin I to Predict Outcome in Patients With Newly Detected Atrial Fibrillation. Am J Cardiol 2020; 125:744-750. [PMID: 31883678 DOI: 10.1016/j.amjcard.2019.12.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 11/29/2019] [Accepted: 12/04/2019] [Indexed: 01/15/2023]
Abstract
The prognostic role of high-sensitivity cardiac troponin I (hs-TnI) in patients with newly detected atrial fibrillation (AF) is not well established. We investigate the association of elevated hs-TnI with clinical outcomes and explore the utility of hs-TnI for risk assessment in patients with newly detected AF. From August 2014 to December 2016, 2,361 consecutive patients with newly detected AF were enrolled in a retrospective, single-center registry. Of these, 957 patients were selected and classified into 4 groups according to hs-TnI quartiles. The primary outcome was all-cause death during follow-up. The hs-TnI level was 3.6 ng/L or less in the lowest quartile (Q1), more than 3.6 ng/L to 10.1 ng/L or less in the second quartile (Q2), more than 10.1 ng/L to 22.0 ng/L or less in the third quartile (Q3), and more than 22.0 ng/L in the highest quartile (Q4). The median follow-up period was 19.3 months. In multivariable Cox regression model, Q4 has a higher risk of all-cause death (adjusted hazard ratio [HR]: 3.49; 95% confidence interval [CI]: 1.21 to 10.00; p = 0.02), readmission for heart failure (adjusted HR: 1.75; 95% CI: 1.01-3.05; p = 0.04), and readmission for revascularization (adjusted HR: 3.90; 95% CI: 1.25 to 12.17; p = 0.02) compared with Q1. Independent predictors of all-cause death were renal insufficiency (adjusted HR: 1.96; 95% CI: 1.08 to 3.53; p = 0.02), highest hs-TnI quartile (adjusted HR: 3.30; 95% CI: 1.18 to 9.27; p = 0.02) and anticoagulation therapy (adjusted HR: 0.51; 95% CI: 0.27 to 0.93; p = 0.03). Elevated hs-TnI is independently associated with higher mortality in patients with AF and serves as a valuable prognostic biomarker in patients with newly detected AF.
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Affiliation(s)
- Bum Sung Kim
- Division of Cardiology, Department of Medicine, Konkuk University Medical Center, School of Medicine, Konkuk University, Seoul 05030, Republic of Korea
| | - Chang Hee Kwon
- Division of Cardiology, Department of Medicine, Konkuk University Medical Center, School of Medicine, Konkuk University, Seoul 05030, Republic of Korea
| | - Haseong Chang
- Division of Cardiology, Department of Medicine, Konkuk University Medical Center, School of Medicine, Konkuk University, Seoul 05030, Republic of Korea
| | - Sung Hea Kim
- Division of Cardiology, Department of Medicine, Konkuk University Medical Center, School of Medicine, Konkuk University, Seoul 05030, Republic of Korea.
| | - Hyun-Joong Kim
- Division of Cardiology, Department of Medicine, Konkuk University Medical Center, School of Medicine, Konkuk University, Seoul 05030, Republic of Korea
| | - Hweung Kon Hwang
- Division of Cardiology, Department of Medicine, Konkuk University Medical Center, School of Medicine, Konkuk University, Seoul 05030, Republic of Korea
| | - Sang-Man Chung
- Division of Cardiology, Department of Medicine, Konkuk University Medical Center, School of Medicine, Konkuk University, Seoul 05030, Republic of Korea
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Zeljkovic I, Knecht S, Spies F, Reichlin T, Schaer B, Osswald S, Kühne M, Sticherling C. High-sensitivity cardiac Troponin T delta concentration after repeat pulmonary vein isolation. Biochem Med (Zagreb) 2019; 29:020902. [PMID: 31223266 PMCID: PMC6559612 DOI: 10.11613/bm.2019.020902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 04/23/2019] [Indexed: 11/25/2022] Open
Abstract
Introduction Difference between high-sensitivity cardiac troponin T concentrations (hs-cTnT) before and after ablation procedure (delta concentration) reflects the amount of myocardial injury. The aim of the study was to investigate hs-cTnT prognostic power for predicting atrial fibrillation (AF) recurrence after repeat pulmonary vein isolation (PVI) procedure. Materials and methods Consecutive patients with paroxysmal AF undergoing repeat PVI using a focal radiofrequency catheter were included in the study. Hs-cTnT was measured before and 18-24 hours after the procedure. Standardized 3, 6 and 12-month follow-up was performed. Cox-regression analysis was used to identify predictors of AF recurrence. Results A total of 105 patients undergoing repeat PVI were analysed (24% female, median age 61 years). Median (interquartile range) hs-cTnT delta after repeat PVI was 283 (127 - 489) ng/L. After a median follow-up of 12 months, AF recurred in 24 (23%) patients. A weak linear relationship between the total radiofrequency energy delivery time and delta hs-cTnT was observed (Pearson R2 = 0.31, P = 0.030). Delta Hs-cTnT was not identified as a significant long-term predictor of AF recurrence after repeated PVI (P = 0.920). Conclusion This was the first study evaluating the prognostic power of delta hs-cTnT in predicting AF recurrence after repeat PVI. Delta hs-cTnT does not predict AF recurrence after repeat PVI procedures. Systematic measurement of hs-cTnT after repeat PVI does not add information relevant to outcome.
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Affiliation(s)
- Ivan Zeljkovic
- Cardiology Department, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Sven Knecht
- Cardiology Department, University Hospital Basel, University of Basel, Basel, Switzerland.,Cardiovascular Research Institute Basel, Basel, Switzerland
| | - Florian Spies
- Cardiology Department, University Hospital Basel, University of Basel, Basel, Switzerland.,Cardiovascular Research Institute Basel, Basel, Switzerland
| | - Tobias Reichlin
- Cardiology Department, University Hospital Basel, University of Basel, Basel, Switzerland.,Cardiovascular Research Institute Basel, Basel, Switzerland
| | - Beat Schaer
- Cardiology Department, University Hospital Basel, University of Basel, Basel, Switzerland.,Cardiovascular Research Institute Basel, Basel, Switzerland
| | - Stefan Osswald
- Cardiology Department, University Hospital Basel, University of Basel, Basel, Switzerland.,Cardiovascular Research Institute Basel, Basel, Switzerland
| | - Michael Kühne
- Cardiology Department, University Hospital Basel, University of Basel, Basel, Switzerland.,Cardiovascular Research Institute Basel, Basel, Switzerland
| | - Christian Sticherling
- Cardiology Department, University Hospital Basel, University of Basel, Basel, Switzerland.,Cardiovascular Research Institute Basel, Basel, Switzerland
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Tamura S, Doi A, Matsuo M, Katayama H, Yoshiyama T, Tatsumi H, Izumiya Y, Yoshiyama M. Prognostic value of high-sensitive troponin T for predicting cardiovascular events after atrial fibrillation ablation. J Cardiovasc Electrophysiol 2019; 30:1475-1482. [PMID: 31192482 DOI: 10.1111/jce.14032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 05/27/2019] [Accepted: 06/10/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVES This study aimed to evaluate the utility of high-sensitive troponin T (hs-TnT) for predicting AF recurrence and major adverse cardiovascular events (MACE) after AF ablation. METHODS AND RESULTS A total of 227 consecutive patients with AF (mean age, 66 ± 10 years; persistent AF, n = 98) who underwent an initial ablation were enrolled. We measured hs-TnT before AF ablation and divided the patients into three groups according to the hs-TnT level: low, lesser than or equal to 0.005 µg/L (n = 54); medium, 0.006-0.013 µg/L (n = 127); and high, greater than or equal to0.014 µg/L (n = 46). We evaluated the composite endpoint of AF recurrence or MACE (including death, stroke, acute coronary syndrome, and heart failure hospitalization) after the ablation. The median hs-TnT level was 0.008 µg/L. The values of chronic kidney disease prevalence, CHA2 DS2 -VASc score, B-type natriuretic peptide level, and left atrial diameter were the highest in the high hs-TnT group among the three groups. During a mean follow-up of 15 ± 8 months, AF recurrence and MACE occurred in 56 (25%) and 9 (4%) patients, respectively. The high hs-TnT group had the highest incidence of AF recurrence and MACE among the three groups (high: 39% and 15%, medium: 22% and 2%, and low: 19% and 0%, respectively; log-rank P < .05). In multivariate analysis, hs-TnT greater than or equal to 0.014 µg/L and persistent AF were independent predictors of the composite endpoint. CONCLUSION Hs-TnT may be a useful marker for predicting AF recurrence or MACE after AF ablation.
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Affiliation(s)
- Shota Tamura
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Atsushi Doi
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Masanori Matsuo
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Hisashi Katayama
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Tomotaka Yoshiyama
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Hiroaki Tatsumi
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Yasuhiro Izumiya
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Minoru Yoshiyama
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
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Zeljkovic I, Knecht S, Pavlovic N, Celikyrut U, Spies F, Burri S, Mannhart D, Peterhans L, Reichlin T, Schaer B, Osswald S, Sticherling C, Kuhne M. High-sensitive cardiac troponin T as a predictor of efficacy and safety after pulmonary vein isolation using focal radiofrequency, multielectrode radiofrequency and cryoballoon ablation catheter. Open Heart 2019; 6:e000949. [PMID: 31168374 PMCID: PMC6519429 DOI: 10.1136/openhrt-2018-000949] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 02/26/2019] [Accepted: 03/19/2019] [Indexed: 11/06/2022] Open
Abstract
Introduction Myocardial injury markers such as high-sensitive cardiac troponin T (hs-cTnT) and creatine kinase MB (CK-MB) reflects the amount of myocardial injury with ablation. The aim of the study was to identify the value of myocardial injury markers to predict outcomes after pulmonary vein isolation (PVI) using three different ablation technologies. Methods Consecutive patients undergoing PVI using a standard 3.5 mm irrigated-tip radiofrequency catheter (RF-group), an irrigated multielectrode radiofrequency catheter (IMEA-group) and a second-generation cryoballoon (CB-group) were analysed. Blood samples to measure injury markers were taken before and 18-24 hours after the ablation. Procedural complications were collected and standardised follow-up was performed. Logistic regression was used to identify predictors of recurrence and complications. Results 96 patients (RF group: n=40, IMEA-group: n=17, CB-group: n=39) undergoing PVI only were analysed (82% male, age 59±10 years). After a follow-up of 12 months, atrial fibrillation (AF) recurred in 45% in the RF-group, 29% in the IMEA-group and 36% in the CB-group (p=0.492). Symptomatic pericarditis was observed in 20% of patients in the RF-group, 15% in the IMEA-group and 5% in the CB-group (p=0.131). None of the injury markers was predictive of AF recurrence or PV reconnection after a single procedure. However, hs-cTnT was identified as a predictor of symptomatic pericarditis (OR: 1.003 [1.001 to 1.005], p=0.015). Conclusion Hs-cTnT and CK-MB were significantly elevated after PVI, irrespective of the ablation technology used. None of the myocardial injury markers were predictive for AF recurrence or PV reconnection, but hs-cTnT release predicts the occurrence of symptomatic pericarditis after PVI.
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Affiliation(s)
- Ivan Zeljkovic
- Cardiology, University Hospital Basel, Basel, Switzerland
| | - Sven Knecht
- Cardiology, University Hospital Basel, Basel, Switzerland
| | - Nikola Pavlovic
- Cardiology, Klinicki bolnicki centar Sestre milosrdnice, Zagreb, Croatia
| | | | - Florian Spies
- Cardiology, University Hospital Basel, Basel, Switzerland
| | - Sarah Burri
- Cardiology, University Hospital Basel, Basel, Switzerland
| | | | | | | | - Beat Schaer
- Cardiology, University Hospital Basel, Basel, Switzerland
| | - Stefan Osswald
- Cardiology, University Hospital Basel, Basel, Switzerland
| | | | - Michael Kuhne
- Cardiology, University Hospital Basel, Basel, Switzerland
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Mizia-Stec K, Wieczorek J, Polak M, Wybraniec MT, Woźniak-Skowerska I, Hoffmann A, Nowak S, Wikarek M, Wnuk-Wojnar A, Chudek J, Więcek A. Lower soluble Klotho and higher fibroblast growth factor 23 serum levels are associated with episodes of atrial fibrillation. Cytokine 2018; 111:106-111. [PMID: 30138898 DOI: 10.1016/j.cyto.2018.08.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 06/06/2018] [Accepted: 08/07/2018] [Indexed: 12/17/2022]
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15
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Bai Y, Guo SD, Liu Y, Ma CS, Lip GYH. Relationship of troponin to incident atrial fibrillation occurrence, recurrence after radiofrequency ablation and prognosis: a systematic review, meta-analysis and meta-regression. Biomarkers 2018; 23:512-517. [PMID: 29631448 DOI: 10.1080/1354750x.2018.1463562] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Ying Bai
- Cardiovascular Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Shi-Dong Guo
- Emergency Department of China-Japan Friendship Hospital, Chaoyang District, Beijing, China
| | - Yue Liu
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Chang-Sheng Ma
- Cardiovascular Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Gregory Y. H. Lip
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
- Department of Clinical Medicine, Aalborg Thrombosis Research Unit, Aalborg University, Aalborg, Denmark
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