Ma Jiaxue, Wu Na, Yuan Zhiquan, Chen Yanxiu, Li Chengying, Xie Weijia, Zhang Zhihui, Li Yafei, Zhong Li
Cardiovascular Disease Center, Third Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Department of Epidemiology, College of Preventive Medicine, Army Medical University, Chongqing, China.
Front Cardiovasc Med. 2023 Jan 9;9:1072164. doi: 10.3389/fcvm.2022.1072164. eCollection 2022.
Interleukin (IL)-34 and IL-38 are associated with cardiovascular disease (CVD). However, their involvement in atrial fibrillation (AF) and AF-associated adverse events remains uncertain. Therefore, we aimed to investigate their association with various AF prognostic factors in a cohort study and assessed their predictive value for the prognosis of patients with AF.
Patients with new-onset non-valvular AF were consecutively enrolled between 2013 and 2015 at the Department of Cardiovascular Medicine of the Southwest Hospital of the Army Medical University (Third Military Medical University) in Chongqing, China. The endpoints included stroke and all-cause mortality. The baseline levels of plasma IL-34, IL-38, NT-proBNP, high-sensitivity cardiac troponin T (hs-cTnT), and GDF-15 were measured and their correlation with AF-related adverse events were analyzed in a Cox proportional-hazards regression model. The -statistic, net reclassification improvement (NRI), and integrated discrimination improvement (IDI) were used to evaluate the performance of the AF prognostic models. Decision curve analysis (DCA) was used to evaluate the clinical net benefit of the original and modified models.
A total of 299 patients with new-onset AF were enrolled. During the median follow-up time of 28 (IQR: 27, 29) months, the higher levels of IL-34 were associated with a lower risk of stroke, and the higher levels of IL-38 were associated with an increased risk of all-cause death (all adjusted < 0.05). In addition, elevated hs-cTnT and NT-proBNP concentrations were associated with a higher risk of stroke and all-cause mortality (all adjusted < 0.05). Furthermore, the CHADS-VASc score combined with IL-38 and NT-proBNP significantly improved the -statistic, IDI, and NRI (all < 0.01). There was no statistically significant difference (all > 0.05) in the discrimination power between the preference models and the ABC (age, biomarkers, and clinical history) score for the two prognostic outcomes.
Our results suggested that IL-34 and IL-38 were independently associated with stroke and all-cause mortality in patients with AF. Moreover, adding IL-38 and NT-proBNP to the CHADS-VASc score significantly improved its predictive ability of AF-related all-cause death. Finally, the preference model performed equally well as the ABC score in predicting AF prognosis.
白细胞介素（IL）-34和IL-38与心血管疾病（CVD）相关。然而，它们在心房颤动（AF）及AF相关不良事件中的作用仍不确定。因此，我们旨在通过一项队列研究调查它们与各种AF预后因素的关联，并评估它们对AF患者预后的预测价值。
2013年至2015年期间，在中国重庆陆军军医大学（第三军医大学）西南医院心血管内科连续纳入新发非瓣膜性AF患者。终点事件包括卒中及全因死亡。检测血浆IL-34、IL-38、N末端脑钠肽原（NT-proBNP）、高敏心肌肌钙蛋白T（hs-cTnT）和生长分化因子15（GDF-15）的基线水平，并在Cox比例风险回归模型中分析它们与AF相关不良事件的相关性。使用-统计量、净重新分类改善（NRI）和综合判别改善（IDI）来评估AF预后模型的性能。决策曲线分析（DCA）用于评估原始模型和改良模型的临床净效益。
共纳入299例新发AF患者。在中位随访时间28（四分位间距：27，29）个月期间，IL-34水平较高与卒中风险较低相关，而IL-38水平较高与全因死亡风险增加相关（所有校正<0.05）。此外，hs-cTnT和NT-proBNP浓度升高与卒中和全因死亡风险较高相关（所有校正<0.05）。此外，CHADS-VASc评分联合IL-38和NT-proBNP显著改善了-统计量、IDI和NRI（所有<0.01）。对于两种预后结局，偏好模型与ABC（年龄、生物标志物和临床病史）评分之间的判别能力无统计学显著差异（所有>0.05）。
我们的结果表明，IL-34和IL-38与AF患者的卒中和全因死亡独立相关。此外，在CHADS-VASc评分中加入IL-38和NT-proBNP可显著提高其对AF相关全因死亡的预测能力。最后，偏好模型在预测AF预后方面与ABC评分表现相当。
