Department of Cardiology, University Hospital of Split, 21000 Split, Croatia.
Department of Nephrology, University Hospital of Split, 21000 Split, Croatia.
Int J Mol Sci. 2023 Feb 2;24(3):2902. doi: 10.3390/ijms24032902.
The aim of this study was to evaluate the specific neurologic biomarkers, neuroimaging findings, and cognitive function in patients with persistent atrial fibrillation (AF) undergoing electrical cardioversion, compared to control subjects. This cross-sectional study included 25 patients with persistent AF undergoing electrical cardioversion and 16 age- and sex-matched control subjects. Plasma levels of glial fibrillary acidic protein (GFAP), neurofilament light protein (NFL), and ubiquitin carboxyl-terminal hydrolase L1 (UCH-L1), as well as parameters of neuroimaging and cognitive function, were compared between the groups. Neuroimaging was performed using the standard magnetic resonance imaging (MRI) protocol. Cognitive function was assessed using the Patient-Reported Outcomes Measurement Information System (PROMIS) Cognitive Function Index. Further analysis of neurologic biomarkers was performed based on the subsequent electrical cardioversion. There was no significant difference in GFAP (median of 24.7 vs. 28.7 pg/mL, = 0.347), UCH-L1 (median of 112.8 vs. 117.7 pg/mL, = 0.885), and NFL (median of 14.2 vs. 15.4 pg/mL, = 0.886) levels between AF patients and control subjects. Similarly, neuroimaging showed no between-group difference in large cortical and non-cortical lesions (n = 2, 8.0% vs. n = 0, 0.0%, = 0.246), small non-cortical lesions (n = 5, 20.0% vs. n = 5, 31.3%, = 0.413), white matter hyperintensity (n = 23, 92.0% vs. n = 14, 87.5%, = 0.636), and thromboembolic lesions (n = 0, 0.0% vs. n = 1, 6.3%, = 0.206). Cognitive assessment did not show any between-group difference in the PROMIS index (52.2 ± 9.6 vs. 51.2 ± 6.2, = 0.706). Finally, there were no significant dynamics in neurologic biomarkers following electrical cardioversion ( > 0.05). This hypothesis-generating study did not find a significant difference in neurologic biomarkers, neuroimaging findings, or cognitive function between patients with persistent AF and controls. The restoration of sinus rhythm was not significantly associated with a change in neurologic biomarkers. Further powered longitudinal studies are needed to re-assess these findings in an AF population.
本研究旨在评估持续性心房颤动（AF）患者行电复律与对照组之间特定的神经生物标志物、神经影像学表现和认知功能。这项横断面研究纳入了 25 例接受电复律的持续性 AF 患者和 16 例年龄和性别匹配的对照组。比较了两组患者的血浆神经胶质纤维酸性蛋白（GFAP）、神经丝轻链蛋白（NFL）和泛素羧基末端水解酶 L1（UCH-L1）水平以及神经影像学和认知功能参数。使用标准磁共振成像（MRI）方案进行神经影像学检查。使用患者报告的结局测量信息系统（PROMIS）认知功能指数评估认知功能。根据随后的电复律进一步分析神经生物标志物。AF 患者和对照组之间的 GFAP（中位数 24.7 与 28.7 pg/mL， = 0.347）、UCH-L1（中位数 112.8 与 117.7 pg/mL， = 0.885）和 NFL（中位数 14.2 与 15.4 pg/mL， = 0.886）水平无显著差异。神经影像学也显示两组之间大皮质和非皮质病变（n = 2，8.0%与 n = 0，0.0%， = 0.246）、小非皮质病变（n = 5，20.0%与 n = 5，31.3%， = 0.413）、脑白质高信号（n = 23，92.0%与 n = 14，87.5%， = 0.636）和血栓栓塞病变（n = 0，0.0%与 n = 1，6.3%， = 0.206）之间无差异。PROMIS 指数评估的认知评估在两组之间也无差异（52.2 ± 9.6 与 51.2 ± 6.2， = 0.706）。最后，电复律后神经生物标志物无明显变化（ > 0.05）。这项假设生成研究未发现持续性 AF 患者与对照组之间在神经生物标志物、神经影像学表现或认知功能方面存在显著差异。窦性节律的恢复与神经生物标志物的变化无显著相关性。需要进一步进行有力的纵向研究，以在 AF 人群中重新评估这些发现。
