Wakula Paulina, Neumann Benjamin, Kienemund Jens, Thon-Gutschi Eva, Stojakovic Tatjana, Manninger Martin, Scherr Daniel, Scharnagl Hubert, Kapl Martin, Pieske Burkert, Heinzel Frank R
Department of Cardiology, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, Berlin 13353, Germany.
DZHK (German Center for Cardiovascular Research), partner site, Berlin, Germany.
Europace. 2017 Apr 1;19(4):544-551. doi: 10.1093/europace/euw101.
Paroxysmal atrial fibrillation (PAF) is often asymptomatic but nonetheless harmful. We evaluated the performance of disease-related blood biomarkers and CHA2DS2-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, TGFβ1, 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 CHADS2-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 CHADS2-VASc for PAF was increased by addition of selected biomarkers.
阵发性心房颤动（PAF）通常无症状，但仍具有危害性。我们评估了疾病相关血液生物标志物和CHA2DS2-VASc评分在持续心律监测患者中鉴别PAF的性能。
从根据近期设备记录中有无心房高速率发作（AHRE）>6分钟选择的双腔起搏器患者中获取临床数据和血样（病例对照法）。我们纳入了93例患者（49例有AHRE，44例无AHRE）。在一个AHRE负荷高且确诊PAF的亚组中评估了15种生物标志物（19例AHRE-AF对20例无AHRE）。然后在所有患者中测试显著调节的生物标志物以区分无AHRE与AHRE（受试者操作特征分析）。热休克蛋白27（Hsp27）、转化生长因子β1（TGFβ1）、胱抑素C、基质金属蛋白酶MMP-2、-3、-9、白蛋白和血清尿酸在亚组中未改变。金属蛋白酶组织抑制剂（TIMP）-1、-2、-4；N末端前脑钠肽原（NT-proANP）、N末端脑钠肽原（NT-proBNP）、白细胞介素-6（IL-6）和血清淀粉样蛋白A在AHRE与无AHRE之间有显著差异（亚组和整个队列），TIMP-4的鉴别性能最佳。生物标志物在鉴别AHRE方面比CHA2DS2-VASc表现更好。7例AHRE患者的心内电图和病史提示为房性心动过速而非房颤（AHRE-AT）。4种最相关的调节生物标志物（TIMP-4、TIMP-2、血清淀粉样蛋白A（SAA）、NT-proBNP）在AHRE-AT和AHRE-AF中的表现相似。NT-proBNP>150 pg/mL表明AHRE的比值比为12.9。联合两种生物标志物显著改善了对AHRE的鉴别。
TIMP-4、NT-proANP、NT-proBNP与PAF和AHRE的相关性最强。通过添加选定的生物标志物提高了CHADS2-VASc对PAF的鉴别性能。
