title: Characterisation and validity of inflammatory biomarkers in the prediction of post-operative atrial fibrillation in coronary artery disease patients.
abstract: Atrial fibrillation (AF) is a common complication of coronary artery bypass grafting (CABG). We sought to determine the diagnostic validity of plasma biomarkers of i) inflammation (marked by interleukin-6 [IL-6] and high-sensitivity C-reactive protein [hs-CRP]), ii) extracellular matrix remodelling (matrix metalloproteinase [MMP-9], tissue inhibitor of matrix metalloproteinase [TIMP-1]) and iii) the prothrombotic state (tissue factor and von Willebrand factor [vWF]) in the risk prediction of post-operative AF. Samples were obtained preoperatively from peripheral/femoral vein and from intracardiac chambers (right atrium [RA], the right atrial appendage [RAA], the left atrium [LA] and the left atrial appendage [LAA]) amongst 100 consecutive patients free of AF and inflammatory disease undergoing elective CABG. Biomarker concentrations were related to incident AF (30 days). At 30 days post CABG, 30 patients were proven to have had AF. Concentrations of tissue factor (TF) and vWF were unrelated to postoperative AF. Peripheral (p=0.018), and intracardiac levels (RAA (p=0.029) and LA (p=0.026)) of hs-CRP were associated with the presence of AF after CABG. Intracardiac levels of IL-6 in samples from the RAA (p=0.031), LA (p=0.042) and LAA (p=0.006), and MMP-9 in the LAA sample were also associated with AF (p=0.007). Our data suggest that an intra-cardiac inflammatory environment that is manifest peri-operatively may predispose to the development of post-operative AF. This intracardiac inflammatory state was reflected by increased peripheral hs-CRP levels. These differences may indicate local substrate abnormalities contributing to the development of AF post-operatively.
authors.affiliation: Haemostasis, Thrombosis, and Vascular Biology Unit, Department of Medicine, University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, UK.
authors.forename: Diana
authors.initials: D
authors.lastname: Kaireviciute
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Blann
authors.forename: Balu
authors.initials: B
authors.lastname: Balakrishnan
authors.forename: Deirdre A
authors.initials: DA
authors.lastname: Lane
authors.forename: Jeetesh V
authors.initials: JV
authors.lastname: Patel
authors.forename: Giedrius
authors.initials: G
authors.lastname: Uzdavinys
authors.forename: Gediminas
authors.initials: G
authors.lastname: Norkunas
authors.forename: Gintaras
authors.initials: G
authors.lastname: Kalinauskas
authors.forename: Vytautas
authors.initials: V
authors.lastname: Sirvydis
authors.forename: Audrius
authors.initials: A
authors.lastname: Aidietis
authors.forename: Gregory Y H
authors.initials: GY
authors.lastname: Lip
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000097:blood / Q000175:diagnosis* / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery; D015415:Biomarkers / Q000378:metabolism; D002097:C-Reactive Protein / Q000276:immunology / Q000378:metabolism; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D003324:Coronary Artery Disease / Q000097:blood / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery; D005260:Female; D006801:Humans; D007249:Inflammation; D015850:Interleukin-6 / Q000235:genetics / Q000378:metabolism; D008297:Male; D020780:Matrix Metalloproteinase 9 / Q000276:immunology / Q000378:metabolism; D008875:Middle Aged; D011183:Postoperative Complications; D011237:Predictive Value of Tests; D011379:Prognosis; D015203:Reproducibility of Results; D013925:Thromboplastin / Q000378:metabolism
chemical_list: D015415:Biomarkers; D015850:Interleukin-6; D002097:C-Reactive Protein; D013925:Thromboplastin; D020780:Matrix Metalloproteinase 9