CHA(2)DS(2)-VASc score and blood biomarkers to identify patients with atrial high-rate episodes and paroxysmal atrial fibrillation

Wakula, Paulina; Neumann, Benjamin; Kienemund, Jens; Thon-Gutschi, Eva; Stojakovic, Tatjana; Manninger, Martin; Scherr, Daniel; Scharnagl, Hubert; Kapl, Martin; Pieske, Burkert and Heinzel, Frank R. (2017): CHA(2)DS(2)-VASc score and blood biomarkers to identify patients with atrial high-rate episodes and paroxysmal atrial fibrillation. In: Europace, Vol. 19, No. 4: pp. 544-551

Abstract

Paroxysmal atrial fibrillation (PAF) is often asymptomatic but nonetheless harmful. We evaluated the performance of disease-related blood biomarkers and CHA(2)DS(2)-VASc score to discriminate for PAF in patients with continuous rhythm monitoring. Clinical data and blood samples were obtained from patients with dual-chamber pacemakers selected according to the absence (no_AHRE) or presence of Atrial High-Rate Episodes (AHRE) > 6 min in recent device history (case-control approach). We included 93 patients (n = 49 AHRE, n = 44 no_AHRE). In a subgroup with high AHRE burden and confirmed PAF 15 biomarkers were evaluated (n = 19 AHRE-AF vs. n = 20 no_AHRE). Significantly regulated biomarkers were then tested in all patients to distinguish no_AHRE from AHRE (receiver operating characteristics analysis). Hsp27, TGF beta 1, cystatin C, matrix metalloproteinases MMP-2,-3,-9, albumin, and serum uric acid were not altered in the subgroup. Tissue inhibitors of metalloproteinases (TIMP) -1,-2,-4;NT-proANP, NT-proBNP, IL-6 and serum amyloid protein A were significantly different in AHRE vs. no_AHRE (subgroup and whole cohort), with best discriminatory performance for TIMP-4. Biomarkers performed better than CHADS(2)-VASc for AHRE discrimination. Intracardial electrograms and medical history from seven AHRE patients suggested atrial tachycardia and not AF (AHRE-AT). Four of the most relevant regulated biomarkers (TIMP-4, TIMP-2, SAA, NT-proBNP) behaved similarly in AHRE-AT and AHRE-AF. NT-proBNP > 150 pg/mL indicated an odds ratio of 12.9 for AHRE. Combining two biomarkers significantly improved discrimination of AHRE. TIMP-4, NT-proANP, NT-proBNP were strongest associated with PAF and AHRE. The discriminatory performance of CHADS(2)-VASc for PAF was increased by addition of selected biomarkers.

• Item Type: Journal article
• Faculties: Medicine
• Subjects: 600 Technology > 610 Medicine and health
• ISSN: 1099-5129
• Language: English