Hatzinikolaou-Kotsakou Eleni, Tziakas Dimitrios, Hotidis Athanasios, Stakos Dimitrios, Floros Dimitrios, Papanas Nikolaos, Chalikias Georgios, Maltezos Efstratios, Hatseras Dimitrios Ioanni
Academic Department of Cardiology, Academic General Hospital Alexandroupolis Demokritus University of Thrace, Thrace, Greece.
Am J Cardiol. 2006 Mar 1;97(5):659-61. doi: 10.1016/j.amjcard.2005.09.104. Epub 2006 Jan 6.
The presence of systemic inflammation determined by elevations in high-sensitivity C-reactive protein (hs-CRP) has been associated with persistence of atrial fibrillation (AF). The influence of inflammation markers, such as hs-CRP, on the recurrences of lone AF, however, has not been clarified. We tested the hypothesis of whether, in patients with a first paroxysmal episode of lone AF, the hs-CRP levels were elevated, and whether elevated hs-CRP could predict the recurrence rate of lone AF in patients without antiarrhythmic drugs. Using a case-control study design, the hs-CRP levels in 125 patients with a documented symptomatic first paroxysmal episode of lone AF was compared with the hs-CRP levels in 65 control patients. hs-CRP levels are presented as median values with the interquartile range (25th to 75th percentiles). The hazard ratio compared the 75th percentile of hs-CRP with the 25th percentile. In the arrhythmia group, hs-CRP was higher than in the control patients (median 0.23 mg/dl, interquartile range 0.12 to 0.49, vs 0.087 mg/dl, interquartile range 0.058 to 0.098, p <0.001). After adjusting for baseline characteristics, including, age, gender, and baseline blood pressure, hs-CRP remained a significant predictor of recurrent AF (hazard ratio 1.15, 95% confidence interval 1.04 to 1.24, p = 0.002) at 2 years of follow-up. In conclusion, this study is the first to document that the first paroxysmal episode of lone AF is associated with elevated hs-CRP levels, suggesting that hs-CRP may be a marker for inflammatory states that may promote the initiation of lone AF. These pathways may represent a novel mechanism by which structural changes resulting from inflammation could induce lone AF. The elevated hs-CRP levels could also predict the recurrence rate of lone AF in patients without antiarrhythmic drugs.
高敏C反应蛋白（hs-CRP）升高所确定的全身炎症的存在与心房颤动（AF）的持续存在有关。然而，炎症标志物如hs-CRP对孤立性AF复发的影响尚未阐明。我们检验了以下假设：在首次阵发性孤立性AF发作的患者中，hs-CRP水平是否升高，以及升高的hs-CRP是否能预测未使用抗心律失常药物的患者孤立性AF的复发率。采用病例对照研究设计，将125例有记录的首次阵发性症状性孤立性AF发作患者的hs-CRP水平与65例对照患者的hs-CRP水平进行比较。hs-CRP水平以中位数及四分位数间距（第25至75百分位数）表示。风险比将hs-CRP的第75百分位数与第25百分位数进行比较。在心律失常组中，hs-CRP高于对照患者（中位数0.23mg/dl，四分位数间距0.12至0.49，对照为0.087mg/dl，四分位数间距0.058至0.098，p<0.001）。在对包括年龄、性别和基线血压在内的基线特征进行调整后，hs-CRP在2年随访时仍是复发性AF的显著预测因子（风险比1.15，95%置信区间1.04至1.24，p = 0.002）。总之，本研究首次证明首次阵发性孤立性AF发作与hs-CRP水平升高有关，提示hs-CRP可能是炎症状态的标志物，炎症状态可能促进孤立性AF的起始。这些途径可能代表一种新机制，通过该机制炎症导致的结构改变可诱发孤立性AF。升高的hs-CRP水平还可预测未使用抗心律失常药物患者孤立性AF的复发率。
