title: Type III procollagen-N-peptide as a predictor of persistent atrial fibrillation recurrence after cardioversion.
abstract: OBJECTIVE
  Fibrosis and inflammation may play a significant role in the pathogenesis of atrial fibrillation (AF) recurrence. Type III procollagen-N-peptide (PIIINP) may be related to atrial fibrosis and play a role in predicting the recurrence of AF. We investigated whether PIIINP as a fibrosis marker predicts the recurrence of AF after cardioversion.
  
  
  RESULTS
  Serum PIIINP, interleukin-6, high-sensitivity C-reactive protein, brain natriuretic peptide, renin and aldosterone were measured at baseline and 24 months in 88 patients (62%) with sinus rhythm (SR) maintenance and 54 patients (38%) with AF recurrence. Furthermore, the root mean square voltage in the last 20 ms (RMS20) via P-wave signal-averaged electrocardiogram (P-SAECG) was measured and the relationship between fibrosis biomarkers and RMS20 was examined. Baseline PIIINP with AF recurrence was significantly higher than for those with SR maintenance (0.664 vs. 0.581 U/mL, P = 0.001). However, there were no significant differences in other biomarkers. A logistic regression identified PIIINP (odds ratio 2.61, P = 0.008) as an independent predictor of AF recurrence. The RMS20 as measured by P-SAECG with SR maintenance and PIIINP levels <0.72 U/mL (at baseline) was significantly higher after 24 months than at baseline. Furthermore, the RMS20 with AF recurrence and PIIINP levels >0.72 U/mL (at baseline) was significantly lower after 24 months than baseline.
  
  
  CONCLUSIONS
  Elevated baseline PIIINP concentration is an independent predictor for AF recurrence after cardioversion. Furthermore, there is a relationship between PIIINP and RMS20 and the fibrosis of AF.
authors.affiliation: The Division of Cardiology, Showa University School of Medicine, Tokyo, Japan. mitsuhitoharu@yahoo.co.jp
authors.forename: Mitsuharu
authors.initials: M
authors.lastname: Kawamura
authors.forename: Yumi
authors.initials: Y
authors.lastname: Munetsugu
authors.forename: Shiro
authors.initials: S
authors.lastname: Kawasaki
authors.forename: Katsumi
authors.initials: K
authors.lastname: Onishi
authors.forename: Yoshimasa
authors.initials: Y
authors.lastname: Onuma
authors.forename: Miwa
authors.initials: M
authors.lastname: Kikuchi
authors.forename: Kaoru
authors.initials: K
authors.lastname: Tanno
authors.forename: Youichi
authors.initials: Y
authors.lastname: Kobayashi
mesh_terms: D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000097:blood* / Q000453:epidemiology / Q000517:prevention & control*; D015415:Biomarkers / Q000097:blood; D004554:Electric Countershock / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010446:Peptide Fragments / Q000097:blood*; D015995:Prevalence; D011347:Procollagen / Q000097:blood*; D011379:Prognosis; D015203:Reproducibility of Results; D018570:Risk Assessment; D055502:Secondary Prevention; D012680:Sensitivity and Specificity; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; D011347:Procollagen; C041876:procollagen Type III-N-terminal peptide