Circulating biomarkers of fibrosis and cardioversion of atrial fibrillation: A prospective, controlled cohort study.
BACKGROUND
External direct current cardioversion (DCCV) is an established treatment for AF but is associated with procedural risk and high AF recurrence rates. Cardiac fibrosis has been associated with AF, and circulating biomarkers have been suggested as a method of its assessment, but which biomarkers are suitable is yet to be determined. This study examines the differences between levels of procollagen type III N terminal peptide (PIIINP), type I collagen carboxyl telopeptide (ICTP), galectin-3 (gal-3) and fibroblast growth factor 23 (FGF-23) in DCCV patients, and disease-and-age-matched controls. Their predictive value for AF recurrence was analysed.


METHODS
79 patients undergoing DCCV and 40 age-and-disease-matched controls were included. Biomarkers were analysed using ELISA. Linear regression was used to examine relationships between biomarker levels and baseline characteristics, including echocardiographic measurements. Cox regression was used to assess relationships between baseline characteristics, including biomarker levels, and AF recurrence.


RESULTS
There was no statistically significant difference between biomarker levels in the DCCV and control groups. Diabetes mellitus was related to higher FGF-23 (p=0.007) and PIIINP (p=0.027). Female sex (p=0.014), hypertension (p=0.001), and higher body mass index (p≤0.001) were related to higher gal-3 levels. FGF-23 was weakly predictive of AF recurrence (HR 1.003 p=0.012).


CONCLUSIONS
PIIINP, ICTP, and Gal-3 are not predictive of AF recurrence after DCCV. FGF-23 may be associated with arrhythmia recurrence, but further work is required to clarify this. The presence of AF has no effect on levels of these biomarkers when compared to age and disease-matched controls.
Department of Cardiology, Leeds General Infirmary, LS1 3EX, UK; Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds, LS2 9JT, UK. Electronic address: gordon.begg@nhs.net.
Gordon A
GA
Begg
University of Birmingham Institute of Cardiovascular Science, City Hospital, Birmingham, UK; Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
Gregory Y H
GY
Lip
Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds, LS2 9JT, UK.
Sven
S
Plein
Department of Cardiology, Leeds General Infirmary, LS1 3EX, UK.
Muzahir H
MH
Tayebjee
D000368:Aged; D001281:Atrial Fibrillation / Q000097:blood / Q000628:therapy*; D015415:Biomarkers / Q000097:blood*; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D000089703:Fibroblast Growth Factor-23; D005355:Fibrosis / Q000097:blood*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies
D015415:Biomarkers; C000717427:FGF23 protein, human; D000089703:Fibroblast Growth Factor-23
Atrial fibrillation; Biomarkers; Cardioversion; Fibrosis