First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece.
Curr Med Chem. 2019;26(5):888-897. doi: 10.2174/0929867324666171006155516.
Atrial fibrillation (AF) is the most frequently encountered cardiac arrhythmia globally and substantially increases the risk for thromboembolic disease. Albeit, 20% of all cases of AF remain undiagnosed. On the other hand, hypertension amplifies the risk for both AF occurrences through hemodynamic and non-hemodynamic mechanisms and cerebrovascular ischemia. Under this prism, prompt diagnosis of undetected AF in hypertensive patients is of pivotal importance.
We conducted a review of the literature for studies with biomarkers that could be used in AF diagnosis as well as in predicting the transition of paroxysmal AF to sustained AF, especially in hypertensive patients.
Potential biomarkers for AF can be broadly categorized into electrophysiological, morphological and molecular markers that reflect the underlying mechanisms of adverse atrial remodeling. We focused on P-wave duration and dispersion as electrophysiological markers, and left atrial (LA) and LA appendage size, atrial fibrosis, left ventricular hypertrophy and aortic stiffness as structural biomarkers, respectively. The heterogeneous group of molecular biomarkers of AF encompasses products of the neurohormonal cascade, including NT-pro BNP, BNP, MR-pro ANP, polymorphisms of the ACE and convertases such as corin and furin. In addition, soluble biomarkers of inflammation (i.e. CRP, IL-6) and fibrosis (i.e. TGF-1 and matrix metalloproteinases) were assessed for predicting AF.
The reviewed individual biomarkers might be a valuable addition to current diagnostic tools but the ideal candidate is expected to combine multiple indices of atrial remodeling in order to effectively detect both AF and adverse characteristics of high risk patients with hypertension.
房颤（AF）是全球最常见的心律失常，大大增加了血栓栓塞性疾病的风险。尽管如此，仍有 20%的 AF 病例未被诊断。另一方面，高血压通过血流动力学和非血流动力学机制以及脑血管缺血增加了 AF 发生的风险。在这种情况下，及时诊断高血压患者未被发现的 AF 至关重要。
我们对具有可用于 AF 诊断以及预测阵发性 AF 向持续性 AF 转变的生物标志物的研究进行了文献回顾，特别是在高血压患者中。
AF 的潜在生物标志物可广泛分为反映不良心房重构潜在机制的电生理、形态和分子标志物。我们重点关注 P 波持续时间和离散度作为电生理标志物，以及左心房（LA）和 LA 附件大小、心房纤维化、左心室肥厚和主动脉僵硬作为结构标志物。AF 的分子生物标志物异质性群体包括神经激素级联反应的产物，包括 NT-pro BNP、BNP、MR-pro ANP、ACE 和转化酶（如心钠肽原酶和凝溶胶蛋白原酶）的多态性。此外，还评估了炎症（即 CRP、IL-6）和纤维化（即 TGF-1 和基质金属蛋白酶）的可溶性生物标志物用于预测 AF。
所回顾的个体生物标志物可能是当前诊断工具的有价值补充，但理想的候选标志物预计将结合多个心房重构指标，以便有效地检测 AF 和高血压高危患者的不良特征。
