Cardiovascular Division, School of Medicine, University of Minnesota, Minneapolis (D.A.D.).
Department of Biostatistics, School of Public Health, University of Washington, Seattle (S.R.H.).
Circ Arrhythm Electrophysiol. 2018 Oct;11(10):e006557. doi: 10.1161/CIRCEP.118.006557.
Atrial fibrosis is a hallmark of structural remodeling in atrial fibrillation (AF). Plasma procollagen type III N-terminal propeptide (PIIINP) reflects collagen synthesis and degradation while collagen type I carboxy-terminal telopeptide (ICTP) reflects collagen degradation. We aimed to study baseline plasma PIIINP and ICTP and their associations with incident AF in participants initially free of overt cardiovascular disease.
In a stratified sample of the Multi-Ethnic Study of Atherosclerosis, initially aged 45-84 years, 3071 participants had both PIIINP and ICTP measured at baseline. Incident AF in 10-year follow-up was based on a hospital International Classification of Diseases code for AF or atrial flutter, in- or outpatient Medicare claims through 2011 (primarily in those aged 65-84 years), or ECG 10 years after baseline (n=357). The associations of PIIINP and ICTP with incident AF were estimated using Poisson regression with follow-up time offset.
Baseline PIIINP (5.50±1.55 µg/L) and ICTP (mean±SD, 3.41±1.37 µg/L) were positively related (both P<0.0001) to incident AF in a model adjusting for age, race/ethnicity, and sex, with an apparent threshold (relative incidence density 2.81 [1.94-4.08] for PIIINP ≥8.5 µg/L [3.5% of the sample] and 3.46 [2.36-5.07] for ICTP ≥7 µg/L [1.7% of the sample]). Findings were attenuated but remained statistically significant after further adjustment for systolic blood pressure, height, body mass index, smoking, and renal function. Additional adjustment for other risk factors and biomarkers of inflammation did not alter conclusions.
Plasma collagen biomarkers, particularly at elevated levels, were associated with excess risk for AF.
心房纤维化是心房颤动（AF）结构重构的标志。血浆前胶原 III 型 N 端前肽（PIIINP）反映胶原合成和降解，而 I 型胶原羧基末端肽（ICTP）反映胶原降解。我们旨在研究最初无明显心血管疾病的参与者中，基线血浆 PIIINP 和 ICTP 及其与 AF 事件的相关性。
在动脉粥样硬化多民族研究的分层样本中，3071 名参与者在基线时同时测量了 PIIINP 和 ICTP。10 年随访中的 AF 事件基于 AF 或房性扑动的医院国际疾病分类代码，2011 年之前的医疗保险索赔（主要是年龄在 65-84 岁的患者），或基线后 10 年的 ECG（n=357）。使用基于随访时间的泊松回归估计 PIIINP 和 ICTP 与 AF 事件的相关性。
在调整年龄、种族/民族和性别后，基线 PIIINP（5.50±1.55 µg/L）和 ICTP（均数±标准差，3.41±1.37 µg/L）与 AF 事件呈正相关（均 P<0.0001），在 PIIINP≥8.5 µg/L[样本中 3.5%]和 ICTP≥7 µg/L[样本中 1.7%]的模型中，明显存在阈值（相对发生率密度 2.81[1.94-4.08]和 3.46[2.36-5.07]）。在进一步调整收缩压、身高、体重指数、吸烟和肾功能后，结果减弱但仍有统计学意义。进一步调整其他危险因素和炎症生物标志物并未改变结论。
血浆胶原生物标志物，尤其是在升高水平时，与 AF 的风险增加相关。
