Plasma asymmetric dimethylarginine and adverse events in patients with atrial fibrillation referred for coronary angiogram.
OBJECTIVE
Elevated plasma levels of asymmetric dimethylarginine (ADMA) have been reported to be associated with endothelial dysfunction, inflammation, and oxidative stress in multiple cardiovascular diseases. This study aimed to investigate whether ADMA was a predictor of clinical outcomes in atrial fibrillation (AF).


RESULTS
From 2006-2009, 990 individuals were referred to our institution for coronary angiography. Among these patients, 141 subjects with a diagnosis of AF, including 52 paroxysmal AF (PAF) and 89 non-paroxysmal AF (non-PAF) patients, were identified as the study population. Plasma ADMA levels were measured. An adverse event was defined as the occurrence of ischemic stroke or cardiovascular death. The ADMA levels were higher in AF than non-AF patients (0.50 ± 0.13 versus 0.45 ± 0.07 µmol/L; p<0.001). Besides, non-PAF patients had higher ADMA levels than PAF patients (0.52 ± 0.15 versus 0.48 ± 0.08 µmol/L; p<0.001). During the follow-up of 30.7±14.4 months, 21 patients (14.9%) experienced adverse events, including cardiovascular death in 7 patients and ischemic stroke in 14. ADMA level, CHA2DS2-VASc score, and left atrial diameter were independent predictors of adverse events in the multivariate analysis. At a cutoff-value of 0.55 µmol/L, the Kaplan-Meier survival analysis showed that patients with a high ADMA level had a higher event rate during the follow-up period.


CONCLUSIONS
A higher level of ADMA was a risk factor of adverse events in AF patients, which was independent from the CHA2DS2-VASc score. It deserves to further study whether ADMA could potentially refine the clinical risk stratification in AF.
Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
Tze-Fan
TF
Chao
Tse-Min
TM
Lu
Yenn-Jiang
YJ
Lin
Hsuan-Ming
HM
Tsao
Shih-Lin
SL
Chang
Li-Wei
LW
Lo
Yu-Feng
YF
Hu
Ta-Chuan
TC
Tuan
Ming-Hsiung
MH
Hsieh
Shih-Ann
SA
Chen
D000368:Aged; D000369:Aged, 80 and over; D001120:Arginine / Q000031:analogs & derivatives* / Q000097:blood; D001281:Atrial Fibrillation / Q000097:blood* / Q000150:complications; D002318:Cardiovascular Diseases / Q000097:blood / Q000150:complications / Q000401:mortality; D017023:Coronary Angiography / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D018570:Risk Assessment / Q000706:statistics & numerical data; D012307:Risk Factors; D020521:Stroke / Q000097:blood / Q000150:complications; D015996:Survival Rate; D013997:Time Factors
C018524:N,N-dimethylarginine; D001120:Arginine