Markers of fibrinolysis as predictors for maintenance of sinus rhythm after electrical cardioversion.
BACKGROUND
Inflammation, endothelial dysfunction and metabolic pathways provide possible links between the inflammatory and hypofibrinolytic states in atrial fibrillation. Our aim was to explore the role of mass concentrations of PAI-1 and tPA, activities of PAI-1 and tPA as predictors of recurrence of atrial fibrillation adjusted for CRP.


METHODS
The study included 129 patients with persistent atrial fibrillation. Laboratory analyses were performed including PAI-1 activity, PAI-1 mass, tPA activity, tPA mass and CRP in baseline. Patients were then randomized to atorvastatin (40 mg, two tablets once daily) or placebo, initiated at least 14 days before the elective cardioversion. Further samples and follow-up were made at day 2 and 30 days after cardioversion.


RESULTS
In univariate logistic regression no fibrinolytic variable was significantly correlated with rhythm in day 30. In multivariate analysis lower PAI-1 mass was significantly associated with sinus rhythm in all models including fibrinolytic variables, CRP, metabolic components, age, hypertension and smoking. After adding treatment allocation to the fully adjusted model, PAI-1 mass remained significantly associated with sinus rhythm both at day 2 and 30 (OR 0.98; 95% CI 0.95-1.00).


CONCLUSIONS
No fibrinolytic component alone was found to be a predictor of recurrence of atrial fibrillation. In multivariate models lower PAI-1 mass was associated with sinus rhythm even after adjusting for CRP, markers of the metabolic syndrome and treatment with atorvastatin. Our findings suggest a patophysiological link between AF and PAI-1 mass but the relation to inflammation remains unclear.
Department of Medicine and Geriatrics, Skellefteå County Hospital, S-931 86 Skellefteå, Sweden. jonas.so.andersson@vll.se
Jonas
J
Andersson
Henrik
H
Almroth
Niklas
N
Höglund
Steen
S
Jensen
Per
P
Tornvall
Anders
A
Englund
Mårten
M
Rosenqvist
Kurt
K
Boman
D000368:Aged; D000924:Anticholesteremic Agents / Q000627:therapeutic use; D000069059:Atorvastatin; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000517:prevention & control* / Q000628:therapy; D002097:C-Reactive Protein; D004554:Electric Countershock; D005260:Female; D005342:Fibrinolysis; D006538:Heptanoic Acids / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D017395:Plasminogen Activator Inhibitor 1; D011758:Pyrroles / Q000627:therapeutic use; D012008:Recurrence; D010959:Tissue Plasminogen Activator
D000924:Anticholesteremic Agents; D006538:Heptanoic Acids; D017395:Plasminogen Activator Inhibitor 1; D011758:Pyrroles; D002097:C-Reactive Protein; D000069059:Atorvastatin; D010959:Tissue Plasminogen Activator