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Kato R. B-Type Natriuretic Peptide Level for Atrial Fibrillation Ablation - Is It a Wonderful Fortune Teller or a Mirror Reflecting Reality? Circ J 2023; 87:1740-1741. [PMID: 37899251 DOI: 10.1253/circj.cj-23-0728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Affiliation(s)
- Ritsushi Kato
- Department of Cardiology, Saitama Medical University, International Medical Center
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2
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Younes H, Mekhael M, Feng H, Noujaim C, Chouman N, Assaf A, Hajjar AHE, Ayoub T, Dagher L, Lim C, Pandey A, Kreidieh O, Marrouche N, Donnellan E. Baseline natriuretic peptides as a predictor of atrial fibrillation recurrence after radiofrequency-based pulmonary vein isolation in a non-heart failure population: A subanalysis from DECAAF II. Pacing Clin Electrophysiol 2023; 46:848-854. [PMID: 37350127 DOI: 10.1111/pace.14762] [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: 03/03/2023] [Revised: 05/25/2023] [Accepted: 06/03/2023] [Indexed: 06/24/2023]
Abstract
BACKGROUND Brain natriuretic peptide (BNP) is a marker of myocardial stretch and may have prognostic significance in patients with atrial fibrillation (AF) without heart failure (HF). We investigated the association between baseline BNP levels and arrhythmia recurrence following pulmonary vein isolation (PVI) among patients with persistent AF without HF. METHODS We analyzed 125 patients with persistent AF without HF who had baseline BNP measured from the DECAAF II trial. The primary outcome was arrhythmia recurrence following ablation. The baseline characteristics across the two groups were compared using Chi-square test and Wilcoxon rank test accordingly. Cox regression analysis was used to analyze the association between baseline BNP levels and the primary outcome. RESULTS Across the entire cohort, 64 (51%) patients experienced arrhythmia recurrence. When comparing patients who experienced arrythmia recurrence to patients who did not, patients with recurrent arrhythmia had higher levels of pre-ablation BNP, as evidenced by differences in means (330.05 pg/mL) compared to patients without recurrent arrhythmia (182.39 pg/mL) (p < .05). A cut-off BNP value of 300 pg/mL provided the largest area under curve (AUC) of receiver-operating characteristic (ROC) curve on univariate logistic regression. On unadjusted Cox analysis, for every 100 unit increase in BNP, the hazard ratio for the primary outcome increased 1.09 (1.026-1.158) times (p = .004). After adjusting for sex, hypertension, and stroke, the results remained significant (HR = 1.8516, CI 95% [1.0139 - 3.381], p = .045). CONCLUSION In the non-heart failure population, BNP levels predict AF recurrence following PVI in persistent AF patients.
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Affiliation(s)
- Hadi Younes
- Tulane Research and Innovation for Arrhythmia Discoveries-TRIAD Center, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Mario Mekhael
- Tulane Research and Innovation for Arrhythmia Discoveries-TRIAD Center, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Han Feng
- Tulane Research and Innovation for Arrhythmia Discoveries-TRIAD Center, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Charbel Noujaim
- Tulane Research and Innovation for Arrhythmia Discoveries-TRIAD Center, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Nour Chouman
- Tulane Research and Innovation for Arrhythmia Discoveries-TRIAD Center, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Ala Assaf
- Tulane Research and Innovation for Arrhythmia Discoveries-TRIAD Center, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Abdel-Hadi El Hajjar
- Tulane Research and Innovation for Arrhythmia Discoveries-TRIAD Center, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Tarek Ayoub
- Tulane Research and Innovation for Arrhythmia Discoveries-TRIAD Center, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Lilas Dagher
- Tulane Research and Innovation for Arrhythmia Discoveries-TRIAD Center, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Chanho Lim
- Tulane Research and Innovation for Arrhythmia Discoveries-TRIAD Center, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Amitabh Pandey
- Tulane Research and Innovation for Arrhythmia Discoveries-TRIAD Center, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Omar Kreidieh
- Tulane Research and Innovation for Arrhythmia Discoveries-TRIAD Center, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Nassir Marrouche
- Tulane Research and Innovation for Arrhythmia Discoveries-TRIAD Center, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Eoin Donnellan
- Tulane Research and Innovation for Arrhythmia Discoveries-TRIAD Center, Tulane University School of Medicine, New Orleans, Louisiana, USA
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Singleton MJ, Yuan Y, Dawood FZ, Howard G, Judd SE, Zakai NA, Howard VJ, Herrington DM, Soliman EZ, Cushman M. Multiple Blood Biomarkers and Stroke Risk in Atrial Fibrillation: The REGARDS Study. J Am Heart Assoc 2021; 10:e020157. [PMID: 34325516 PMCID: PMC8475705 DOI: 10.1161/jaha.120.020157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background Atrial fibrillation is associated with increased stroke risk; available risk prediction tools have modest accuracy. We hypothesized that circulating stroke risk biomarkers may improve stroke risk prediction in atrial fibrillation. Methods and Results The REGARDS (Reasons for Geographic and Racial Differences in Stroke) study is a prospective cohort study of 30 239 Black and White adults age ≥45 years. A nested study of stroke cases and a random sample of the cohort included 175 participants (63% women, 37% Black adults) with baseline atrial fibrillation and available blood biomarker data. There were 81 ischemic strokes over 5.2 years in these participants. Adjusted for demographics, stroke risk factors, and warfarin use, the following biomarkers were associated with stroke risk (hazard ratio [HR]; 95% CI for upper versus lower tertile): cystatin C (3.16; 1.04–9.58), factor VIII antigen (2.77; 1.03–7.48), interleukin‐6 (9.35; 1.95–44.78), and NT‐proBNP (N‐terminal B‐type natriuretic peptide) (4.21; 1.24–14.29). A multimarker risk score based on the number of blood biomarkers in the highest tertile was developed; adjusted HRs of stroke for 1, 2, and 3+ elevated blood biomarkers, compared with none, were 1.75 (0.57–5.40), 4.97 (1.20–20.5), and 9.51 (2.22–40.8), respectively. Incorporating the multimarker risk score to the CHA2DS2VASc score resulted in a net reclassification improvement of 0.34 (95% CI, 0.04–0.65). Conclusions Findings in this biracial cohort suggested the possibility of substantial improvement in stroke risk prediction in atrial fibrillation using blood biomarkers or a multimarker risk score.
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Affiliation(s)
- Matthew J Singleton
- Section of Cardiology Department of Internal Medicine Wake Forest School of Medicine Winston-Salem NC
| | - Ya Yuan
- Department of Biostatistics University of Alabama at Birmingham AL
| | | | - George Howard
- Department of Biostatistics University of Alabama at Birmingham AL
| | - Suzanne E Judd
- Department of Biostatistics University of Alabama at Birmingham AL
| | - Neil A Zakai
- Departments of Medicine and Pathology & Laboratory Medicine Larner College of Medicine at the University of Vermont Burlington VT
| | | | - David M Herrington
- Section of Cardiology Department of Internal Medicine Wake Forest School of Medicine Winston-Salem NC
| | - Elsayed Z Soliman
- Section of Cardiology Department of Internal Medicine Wake Forest School of Medicine Winston-Salem NC.,Epidemiological Cardiology Research Center Wake Forest School of Medicine Winston-Salem NC
| | - Mary Cushman
- Departments of Medicine and Pathology & Laboratory Medicine Larner College of Medicine at the University of Vermont Burlington VT
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Matsumoto S, Matsunaga-Lee Y, Ishimi M, Ohnishi M, Masunaga N, Tachibana K, Takano Y. Clinical Significance of B-Type Natriuretic Peptide Levels at 3 Months after Atrial Fibrillation Ablation. Diseases 2021; 9:diseases9030049. [PMID: 34287304 PMCID: PMC8293247 DOI: 10.3390/diseases9030049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 06/20/2021] [Accepted: 06/25/2021] [Indexed: 11/20/2022] Open
Abstract
The role of B-type natriuretic peptide (BNP) levels as a predictor of arrhythmia recurrence (AR) after atrial fibrillation (AF) ablation remains unclear. In this study, we investigated the association of BNP levels before and 3 months after ablation with the risk of AR. A total of 234 patients undergoing their first session of AF ablation were included (68% male, mean age of 69 years). The cut-off value for discriminating AR was determined based on the maximum value of the area under the receiver operating characteristic (ROC) curve. The impact of BNP levels on AR was evaluated using Cox regression analysis. ROC curve analysis showed that the area under the curve for BNP at 3 months after the procedure was larger (0.714) compared to BNP levels before ablation (0.593). Elevated levels of BNP 3 months after the procedure (>40.5 pg/mL, n = 96) was associated with a higher risk of AR compared to those without elevated levels (34.4% vs. 10.9%, p < 0.01). Multivariate Cox regression analysis revealed that elevated BNP levels were associated with an increased risk of AR (hazard ratio 2.43; p = 0.014). Elevated BNP levels 3 months after AF ablation were a significant prognostic factor in AR, while baseline BNP levels were not.
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Affiliation(s)
- Sen Matsumoto
- JCHO Hoshigaoka Medical Center, Department of Cardiovascular Medicine, Hirakata 573-8511, Japan; (M.I.); (M.O.); (N.M.); (K.T.); (Y.T.)
- Correspondence: ; Tel.: +81-72-840-2641
| | | | - Masashi Ishimi
- JCHO Hoshigaoka Medical Center, Department of Cardiovascular Medicine, Hirakata 573-8511, Japan; (M.I.); (M.O.); (N.M.); (K.T.); (Y.T.)
| | - Mamoru Ohnishi
- JCHO Hoshigaoka Medical Center, Department of Cardiovascular Medicine, Hirakata 573-8511, Japan; (M.I.); (M.O.); (N.M.); (K.T.); (Y.T.)
| | - Nobutaka Masunaga
- JCHO Hoshigaoka Medical Center, Department of Cardiovascular Medicine, Hirakata 573-8511, Japan; (M.I.); (M.O.); (N.M.); (K.T.); (Y.T.)
| | - Koichi Tachibana
- JCHO Hoshigaoka Medical Center, Department of Cardiovascular Medicine, Hirakata 573-8511, Japan; (M.I.); (M.O.); (N.M.); (K.T.); (Y.T.)
| | - Yuzuru Takano
- JCHO Hoshigaoka Medical Center, Department of Cardiovascular Medicine, Hirakata 573-8511, Japan; (M.I.); (M.O.); (N.M.); (K.T.); (Y.T.)
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Okada M, Tanaka N, Tanaka K, Hirao Y, Yoshimoto I, Harada S, Onishi T, Koyama Y, Okamura A, Iwakura K, Fujii K, Sakata Y, Inoue K. Usefulness of Post-Procedural Plasma Brain Natriuretic Peptide Levels to Predict Recurrence After Catheter Ablation of Atrial Fibrillation in Patients With Left Ventricular Systolic Dysfunction. Am J Cardiol 2021; 144:67-76. [PMID: 33385358 DOI: 10.1016/j.amjcard.2020.12.057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 12/08/2020] [Accepted: 12/11/2020] [Indexed: 01/10/2023]
Abstract
Catheter ablation (CA) of atrial fibrillation (AF) improves cardiac function, resulting in a decrease in plasma brain natriuretic peptide (BNP) levels in patients with reduced left ventricular ejection fraction (LVEF). This study sought to examine the pre-procedural and post-procedural correlations between BNP levels and cardiac function and the associations between the BNP levels and recurrence after CA in patients with AF and reduced LVEF. Of 3142 consecutive patients who underwent first-time CA of AF at our institute, a total of 217 patients with LVEF <50% were enrolled. Significant decrease in BNP levels (from a median of 198 [interquartile range 113 to 355] to 47.7 [22.7 to 135] pg/ml, p <0.001) and improvement in LVEF (from 39±9% to 61±16%, p <0.001) were observed 3 months after CA. There was a linear correlation between log-transformed BNP levels and cardiac measures (LVEF: r = -0.64; LV end-diastolic volume: r = 0.25; LV end-systolic volume: r = 0.43; left atrial volume: r = 0.52; all p <0.001). During a median follow-up of 35 months, AF recurrence after a 3-month blanking period was observed in 80 patients (37%). Cox proportional hazard regression analysis after adjustment for cardiac measures significant in univariate analysis revealed that early recurrence within the blanking period (hazard ratio, 4.88; 95% confidence interval, 2.89 to 8.25) and elevated post-procedural BNP levels (2.02 per unit log increase; 1.14 to 3.56) were significant predictors of AF recurrence, but pre-procedural BNP was not. In conclusion, post-procedural BNP levels at the end of the blanking period predicted subsequent AF recurrence in patients with reduced LVEF, independent of early recurrence.
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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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7
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Deng H, Shantsila A, Guo P, Zhan X, Fang X, Liao H, Liu Y, Wei W, Fu L, Wu S, Xue Y, Lip GY. Multiple biomarkers and arrhythmia outcome following catheter ablation of atrial fibrillation: The Guangzhou Atrial Fibrillation Project. J Arrhythm 2018; 34:617-625. [PMID: 30555605 PMCID: PMC6288553 DOI: 10.1002/joa3.12111] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 06/13/2018] [Accepted: 07/29/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Biomarkers have been related to the arrhythmia recurrence following catheter ablation (CA) of atrial fibrillation (AF). We hypothesized that concurrent measurement of several biomarkers would additively improve their predictive value. METHODS One thousand four hundred and ten consecutive AF patients (68% male; 57.2 ± 11.6 years) undergoing CA were enrolled. Baseline characteristics, serum B type brain natriuretic peptide (BNP) and high sensitivity C reactive protein (hsCRP), estimated glomerular filtration rate (eGFR), ablation parameters, arrhythmia data at discharge, 1, 3, 6, and then every 6 months post CA were collected. Follow-up ended when arrhythmia recurred or until 31st December 2016. RESULTS Three hundred and sixty-five (25.9%) patients had arrhythmia recurrence post-CA during a mean follow-up of 20.7 ± 8.8 months. BNP, hsCRP, and eGFR levels and their cut-off values of 237.45 pg/mL, 1.6 mg/dL, and 82.5 mL/min/1.73 m2 were good predictors for AF recurrence (all P < 0.01). On multivariate analysis, increasing BNP and hsCRP, decreasing eGFR, gender, and early recurrence (ER) were independent predictors of AF recurrence (all P < 0.01). Compared to BNP alone, BNP plus eGFR or both eGFR and CRP showed incrementally better predictive values (ROC comparisons, all P < 0.01). Similar findings were evident in the subgroups of patients with paroxysmal or nonparoxysmal AF. CONCLUSION Measurement of BNP, CRP, and eGFR were incrementally additive to clinical risk factors in a cumulative manner to improve prediction of arrhythmia recurrence post-CA of AF. The implications of poor arrhythmia outcome in AF patients with multiple abnormal biomarkers pre-CA procedure may help with patient selection and inform the likelihood of success or the need of more complicated CA procedure(s).
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Affiliation(s)
- Hai Deng
- Institute of Cardiovascular SciencesUniversity of BirminghamBirminghamUK
- Guangdong Cardiovascular InstituteGuangdong General HospitalGuangdong Academy of Medical SciencesGuangzhouChina
| | - Alena Shantsila
- Institute of Cardiovascular SciencesUniversity of BirminghamBirminghamUK
| | - Pi Guo
- Department of Public HealthMedical College of Shantou UniversityShantouChina
| | - Xianzhang Zhan
- Guangdong Cardiovascular InstituteGuangdong General HospitalGuangdong Academy of Medical SciencesGuangzhouChina
| | - Xianhong Fang
- Guangdong Cardiovascular InstituteGuangdong General HospitalGuangdong Academy of Medical SciencesGuangzhouChina
| | - Hongtao Liao
- Guangdong Cardiovascular InstituteGuangdong General HospitalGuangdong Academy of Medical SciencesGuangzhouChina
| | - Yang Liu
- Guangdong Cardiovascular InstituteGuangdong General HospitalGuangdong Academy of Medical SciencesGuangzhouChina
| | - Wei Wei
- Guangdong Cardiovascular InstituteGuangdong General HospitalGuangdong Academy of Medical SciencesGuangzhouChina
| | - Lu Fu
- Guangdong Cardiovascular InstituteGuangdong General HospitalGuangdong Academy of Medical SciencesGuangzhouChina
| | - Shulin Wu
- Guangdong Cardiovascular InstituteGuangdong General HospitalGuangdong Academy of Medical SciencesGuangzhouChina
| | - Yumei Xue
- Guangdong Cardiovascular InstituteGuangdong General HospitalGuangdong Academy of Medical SciencesGuangzhouChina
| | - Gregory Y.H. Lip
- Institute of Cardiovascular SciencesUniversity of BirminghamBirminghamUK
- Liverpool Centre for Cardiovascular ScienceUniversity of Liverpool and Liverpool Heart & Chest HospitalLiverpoolUK
- Aalborg Thrombosis Research UnitDepartment of Clinical MedicineAalborg UniversityAalborgDenmark
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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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Wang YZ, Fan J, Zhong B, Xu Q. Apelin: A novel prognostic predictor for atrial fibrillation recurrence after pulmonary vein isolation. Medicine (Baltimore) 2018; 97:e12580. [PMID: 30278567 PMCID: PMC6181607 DOI: 10.1097/md.0000000000012580] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Apelin, the ligand for the APJ receptor, is involved in the pathogenesis of atrial fibrillation (AF). However, whether serum apelin can predict the recurrence of AF after pulmonary vein isolation (PVI) has not been determined.A prospective cohort study was performed in patients with AF (but without structural heart disease) who were undergoing first-time PVI. Serum apelin-12 was measured by enzyme-linked immunosorbent assay. Echocardiographic examination was performed at baseline, 3 months, and 6 months after PVI. Patients were followed up for 6 months after PVI, and the association between baseline apelin-12 and AF recurrence (early recurrence: within 3 months after ablation; late recurrence: 3-6 months after ablation) was analyzed.A total of 61 patients were included in the study. Baseline serum level of apelin-12 was significant lower in patients with early (median [interquartile range]: 1844 [1607-2061] vs 2197 [1895-2455] ng/L, P = .01) and late (1639 [1524-1853] vs 1923 [1741-2303] ng/L, P = .02) AF recurrence compared with patients without these events. Results of Cox stepwise multivariate analysis demonstrated that lower baseline apelin-12 (<2265 ng/L) was independently associated with increased AF recurrence within 6 months after PVI (P < .05). The specificity and positive predictive value of apelin-12 for AF recurrence were significantly higher than those of baseline N-terminal brain proBNP (60.4% vs 28.6%, P < .001; 58.8% vs 34.4%, P = .01), although the sensitivity and negative predictive value were similar.Reduced baseline serum apelin-12 may be an independent risk factor for the recurrence of AF after PVI in patients without structural heart disease.
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Affiliation(s)
- Ya Zhu Wang
- Department of Cardiology, The Fifth People's Hospital
| | - Jinqi Fan
- Department of Cardiology, Chongqing Cardiac Arrhythmia Therapeutic Service Center, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Bin Zhong
- Department of Cardiology, The Fifth People's Hospital
| | - Qiang Xu
- Department of Cardiology, The Fifth People's Hospital
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10
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Domínguez H, Madsen CV, Westh ONH, Pallesen PA, Carrranza CL, Irmukhamedov A, Park-Hansen J. Does Left Atrial Appendage Amputation During Routine Cardiac Surgery Reduce Future Atrial Fibrillation and Stroke? Curr Cardiol Rep 2018; 20:99. [PMID: 30171381 PMCID: PMC6132740 DOI: 10.1007/s11886-018-1033-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Purpose of Review Stroke is the most feared complication of atrial fibrillation. To prevent stroke, left atrial appendage exclusion has been targeted, as it is the prevalent site for formation of heart thrombi during atrial fibrillation. We review the historic development of methods for exclusion of the left atrial appendage and the evidence to support its amputation during routine cardiac surgery. Recent Findings Evidence is not yet sufficient to routinely recommend left atrial exclusion during heart surgery, despite a high prevalence of postoperative atrial fibrillation. Observational studies indicate that electrical isolation of scarring from clip or suture techniques reduces the arrhythmogenic substrate. Summary Randomized studies comparing different methods of closure of the left atrial appendage before amputation do not exist. Such studies are therefore warranted, as well as studies that can elucidate whether amputation is superior to leaving the left atrial appendage stump. Potentially, thrombogenic remaining pouch after closure should be addressed.
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Affiliation(s)
- Helena Domínguez
- Department of Cardiology, Bispebjerg-Frederiksberg University Hospital, Nordre Fasanvej 57, vej 4, Building 3, 3rd Floor, DK-2000, Frederiksberg, Denmark. .,Department of Biomedicine, University of Copenhagen, Blegdamsvej 3B, Panum Building 10.5, DK-2400, Copenhagen, Denmark.
| | - Christoffer Valdorff Madsen
- Department of Cardiology, Bispebjerg-Frederiksberg University Hospital, Nordre Fasanvej 57, vej 4, Building 3, 3rd Floor, DK-2000, Frederiksberg, Denmark
| | - Oliver Nøhr Hjorth Westh
- Department of Cardiology, Bispebjerg-Frederiksberg University Hospital, Nordre Fasanvej 57, vej 4, Building 3, 3rd Floor, DK-2000, Frederiksberg, Denmark
| | - Peter Appel Pallesen
- Department of Heart, Lung and Vascular Surgery, Odense University Hospital, Sdr. Boulevard 29, DK-5000, Odense, Denmark
| | - Christian Lildal Carrranza
- Department of Cardio-thoracic Surgery, Blegdamsvej 9, 2100 København, Copenhagen, Rigshospitalet, Denmark
| | - Akhmadjon Irmukhamedov
- Department of Heart, Lung and Vascular Surgery, Odense University Hospital, Sdr. Boulevard 29, DK-5000, Odense, Denmark
| | - Jesper Park-Hansen
- Department of Cardiology, Bispebjerg-Frederiksberg University Hospital, Nordre Fasanvej 57, vej 4, Building 3, 3rd Floor, DK-2000, Frederiksberg, Denmark.,Department of Biomedicine, University of Copenhagen, Blegdamsvej 3B, Panum Building 10.5, DK-2400, Copenhagen, Denmark
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11
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Jiang H, Wang W, Wang C, Xie X, Hou Y. Association of pre-ablation level of potential blood markers with atrial fibrillation recurrence after catheter ablation: a meta-analysis. Europace 2017; 19:392-400. [PMID: 27386883 DOI: 10.1093/europace/euw088] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Accepted: 03/09/2016] [Indexed: 11/13/2022] Open
Abstract
Aims The meta-analysis was aimed to search for candidate blood markers whose pre-ablation level was associated with atrial fibrillation (AF) recurrence after radiofrequency catheter ablation (RFCA). Methods and results A systematic literature search of PubMed, EMBASE, Springer Link, Web of Science, Wiley-Cochrane library, and supplemented with Google scholar search engine was performed. Thirty-six studies covering 11 blood markers were qualified for this meta-analysis. Compared with the nonrecurrence group, the recurrence group had increased pre-ablation level of atrial natriuretic peptide (ANP), brain natriuretic peptide (BNP), N-terminal pro-brain natriuretic peptide (NT-pro-BNP), interleukin-6 (IL-6), C-reactive protein, low density lipoprotein (LDL), and tissue inhibitor of metal loproteinase-2 (TIMP-2) [standardized mean difference (95% confidence interval): 0.37 (0.13-0.61), 0.77 (0.40-1.14), 1.25 (0.64-1.87), 0.37 (0.21-0.52), 0.35 (0.10-0.60), 0.24 (0.07-0.42), 0.17 (0.00-0.34), respectively], while no statistical difference of pre-ablation level of white blood cell, total cholesterol, triglyceride, and transforming growth factor-β1 was found. Subgroup analysis demonstrated that ANP was associated with AF recurrence in participants who had no concomitant structural heart diseases (SHD); however, not in participants who had SHD, C-reactive protein was associated with AF recurrence in Asian studies, whereas not in European studies. Conclusion Increased pre-ablation level of ANP, BNP, NT-pro-BNP, IL-6, C-reactive protein, LDL, and TIMP-2 was associated with greater risk of AF recurrence after RFCA.
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Affiliation(s)
- Hui Jiang
- Department of Clinical Medicine, School of Medicine, Shandong University, Jinan, Shandong Province, China.,Department of Cardiology, Shandong Provincial Qianfoshan Hospital, Shandong University, No. 16766 Jingshi Road, Jinan, Shandong Province 250014, China
| | - Weizong Wang
- Department of Clinical Medicine, School of Medicine, Shandong University, Jinan, Shandong Province, China.,Department of Cardiology, Shandong Provincial Qianfoshan Hospital, Shandong University, No. 16766 Jingshi Road, Jinan, Shandong Province 250014, China
| | - Cong Wang
- Department of Cardiology, Shandong Provincial Qianfoshan Hospital, Shandong University, No. 16766 Jingshi Road, Jinan, Shandong Province 250014, China
| | - Xinxing Xie
- Department of Cardiology, Shandong Provincial Qianfoshan Hospital, Shandong University, No. 16766 Jingshi Road, Jinan, Shandong Province 250014, China
| | - Yinglong Hou
- Department of Cardiology, Shandong Provincial Qianfoshan Hospital, Shandong University, No. 16766 Jingshi Road, Jinan, Shandong Province 250014, China
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Kondo T, Miake J, Kato M, Ogura K, Iitsuka K, Yamamoto K. Impact of postprocedural antiarrhythmic drug therapy with bepridil on maintaining sinus rhythm after catheter ablation for persistent atrial fibrillation. J Cardiol 2016; 68:229-35. [DOI: 10.1016/j.jjcc.2015.09.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 08/23/2015] [Accepted: 09/11/2015] [Indexed: 10/22/2022]
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13
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Zhang Y, Chen A, Song L, Li M, Chen Y, He B. Association Between Baseline Natriuretic Peptides and Atrial Fibrillation Recurrence After Catheter Ablation. Int Heart J 2016; 57:183-9. [DOI: 10.1536/ihj.15-355] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Yunhe Zhang
- Department of Cardiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University
| | - Ao Chen
- Department of Cardiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University
| | - Lei Song
- Department of Cardiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University
| | - Min Li
- Department of Cardiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University
| | - Yingmin Chen
- Department of Cardiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University
| | - Ben He
- Department of Cardiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University
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YANAGISAWA SATOSHI, INDEN YASUYA, KATO HIROYUKI, FUJII AYA, MIZUTANI YOSHIAKI, ITO TADAHIRO, KAMIKUBO YOSUKE, KANZAKI YASUNORI, HIRAI MAKOTO, MUROHARA TOYOAKI. Decrease in B-Type Natriuretic Peptide Levels and Successful Catheter Ablation for Atrial Fibrillation in Patients with Heart Failure. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2015; 39:225-34. [DOI: 10.1111/pace.12788] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 11/11/2015] [Accepted: 11/15/2015] [Indexed: 11/27/2022]
Affiliation(s)
- SATOSHI YANAGISAWA
- Department of Cardiology; Nagoya University Graduate School of Medicine; Nagoya Japan
| | - YASUYA INDEN
- Department of Cardiology; Nagoya University Graduate School of Medicine; Nagoya Japan
| | - HIROYUKI KATO
- Department of Cardiology; Nagoya University Graduate School of Medicine; Nagoya Japan
| | - AYA FUJII
- Department of Cardiology; Nagoya University Graduate School of Medicine; Nagoya Japan
| | - YOSHIAKI MIZUTANI
- Department of Cardiology; Nagoya University Graduate School of Medicine; Nagoya Japan
| | - TADAHIRO ITO
- Department of Cardiology; Nagoya University Graduate School of Medicine; Nagoya Japan
| | - YOSUKE KAMIKUBO
- Department of Cardiology; Nagoya University Graduate School of Medicine; Nagoya Japan
| | - YASUNORI KANZAKI
- Department of Cardiology; Nagoya University Graduate School of Medicine; Nagoya Japan
| | - MAKOTO HIRAI
- Department of Cardiology; Nagoya University Graduate School of Health Science; Nagoya Japan
| | - TOYOAKI MUROHARA
- Department of Cardiology; Nagoya University Graduate School of Medicine; Nagoya Japan
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15
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Kornej J, Husser D, Bollmann A, Lip GYH. Rhythm outcomes after catheter ablation of atrial fibrillation. Clinical implication of biomarkers. Hamostaseologie 2013; 34:9-19. [PMID: 24166596 DOI: 10.5482/hamo-13-09-0051] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Accepted: 10/21/2013] [Indexed: 12/13/2022] Open
Abstract
Atrial fibrillation (AF) occurs as the result of numerous complex physiological processes in the atria leading to AF promotion and maintenance. Improved diagnostic techniques have identified various biomarkers which may play an important role in the prediction of AF related outcomes (cardio- and cerebrovascular events, as well as mortality and rhythm outcomes). Biomarkers refer to 'biological markers' and biomarkers in blood, urine as well as imaging marker (eg, dimensions (left atrial diameter and volume), anatomical features (left appendage and pulmonary vein anatomy), and physiological pattern (LAA flow velocity)) may play important role(s) as clinically important indices in relation to outcomes after different therapeutic strategies. However, the main domain in the biomarker field has focused on blood-based biomarkers, which are widely used to predict therapeutic success regarding underlying pathophysiological mechanism, such as inflammation, fibrosis, endothelial damage. This review provides an update of the role of clinically relevant biomarkers in AF, with particular focus on AF rhythm outcomes.
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Affiliation(s)
| | | | | | - G Y H Lip
- Prof. Gregory Y. H. Lip, Centre for Cardiovascular Sciences, University of Birmingham City Hospital, Birmingham, United Kingdom, E-mail:
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16
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The predictive value of cardiac biomarkers in prognosis and risk stratification of patients with atrial fibrillation. Curr Opin Cardiol 2011; 26:449-56. [PMID: 21765376 DOI: 10.1097/hco.0b013e3283499ed3] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW Atrial fibrillation is a significant public health issue considering its high prevalence in the general population, and is associated with an increased risk of cardiovascular mortality and morbidity and thrombo-embolic complications.Asymptomatic paroxysms of atrial fibrillation occur frequently in the first stages of the disease but patients present to the doctor at a relatively late stage when the associated complications have already taken place. It is crucial to identify such patients as early as possible in order to start preventive therapy. Clinical diagnostic tests to identify patients prone to atrial fibrillation complications have not yet been developed as the exact mechanism and substrate of subclinical atrial fibrillation are not known. Further research is necessary to understand the pathophysiology of subclinical atrial fibrillation and to identify potential risk markers that determine the development and prognosis of the disease. RECENT FINDINGS Biomarkers have recently been identified which have been shown to be related to the incidence of atrial fibrillation and its prognosis. They reflect inflammation, neurohumoral activation and subclinical heart damage. SUMMARY New biomarkers may help to understand the mechanisms of subclinical atrial fibrillation and signal the likelihood of disease progression. Such biomarkers, though subject to further validation, may be of value in predicting the prognosis and guiding the treatment of patients with atrial fibrillation. They may enhance the ability of risk scores to guide anticoagulant treatment strategies.
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Solheim E, Off MK, Hoff PI, De Bortoli A, Schuster P, Ohm OJ, Chen J. N-terminal pro-B-type natriuretic peptide level at long-term follow-up after atrial fibrillation ablation: a marker of reverse atrial remodelling and successful ablation. J Interv Card Electrophysiol 2011; 34:129-36. [DOI: 10.1007/s10840-011-9629-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2011] [Accepted: 09/21/2011] [Indexed: 10/16/2022]
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