Intra-cardiac and peripheral levels of biochemical markers of fibrosis in patients undergoing catheter ablation for atrial fibrillation.
OBJECTIVE
Measurement of circulating biomarkers of fibrosis may have a role in selecting patients and treatment strategy for catheter ablation. Pro-collagen type III N-terminal pro-peptide (PIIINP), C-telopeptide of type I collagen (ICTP), fibroblast growth factor 23 (FGF-23), and galectin 3 (gal-3) have all been suggested as possible biomarkers for this indication, but studies assessing whether peripheral levels reflect intra-cardiac levels are scarce.


RESULTS
We studied 93 patients undergoing ablation for paroxysmal atrial fibrillation (AF) (n = 63) or non-paroxysmal AF (n = 30). Femoral venous, left and right atrial, and coronary sinus blood were analysed using ELISA to determine biomarker levels. Levels were compared with control patients (n = 36) and baseline characteristics, including left atrial voltage mapping data. C-telopeptide of type I collagen levels were higher in AF than in non-AF patients (P = 0.007). Peripheral ICTP levels were higher than all intra-cardiac levels (P < 0.001). Peripheral gal-3 levels were higher than left atrial levels (P = 0.001). Peripheral levels of FGF-23 and PIIINP were not significantly different from intra-cardiac levels. CS levels of ICTP were higher than right and left atrial levels (P < 0.001). gal-3 was higher in women vs. men (P ≤ 0.001) and with higher body mass index (P ≤ 0.001). ICTP levels increased with reducing ejection fraction (P ≤ 0.012).


CONCLUSIONS
Atrial fibrillation patients have higher levels of circulating ICTP than matched non-AF controls. In AF ablation patients, intra-cardiac sampling of FGF-23 or PIIINP gives no further information over peripheral sampling. For gal-3 and ICTP, intra-cardiac sampling may be necessary to assess their association with intra-cardiac processes. None of the biomarkers is related to fibrosis assessed by left atrial voltage.
Department of Cardiology, Leeds General Infirmary, Leeds LS1 3EX, UK.|Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds LS2 9JT, UK.
Gordon A
GA
Begg
Department of Biomedical Engineering, King's College, St. Thomas' Hospital, London, SE1 7EH, UK.
Rashed
R
Karim
Institute of Biomedical Engineering, Karlsruhe Institute of Technology (KIT), 76131 Karlsruhe, Germany.
Tobias
T
Oesterlein
Department of Cardiology, Leeds General Infirmary, Leeds LS1 3EX, UK.
Lee N
LN
Graham
Department of Cardiology, Leeds General Infirmary, Leeds LS1 3EX, UK.
Andrew J
AJ
Hogarth
Department of Cardiology, Leeds General Infirmary, Leeds LS1 3EX, UK.
Stephen P
SP
Page
Department of Cardiology, Leeds General Infirmary, Leeds LS1 3EX, UK.
Christopher B
CB
Pepper
Department of Biomedical Engineering, King's College, St. Thomas' Hospital, London, SE1 7EH, UK.
Kawal
K
Rhode
University of Birmingham Institute of Cardiovascular Science, City Hospital, Birmingham, B18 7QH, UK.|Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
Gregory Y H
GYH
Lip
MCRC and School of Biomedical Sciences, University of Leeds, Leeds LS2 9JT, UK.
Arun V
AV
Holden
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, Leeds LS1 3EX, UK.
Muzahir H
MH
Tayebjee
D000368:Aged; D001281:Atrial Fibrillation / Q000097:blood* / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D064752:Atrial Remodeling; D015415:Biomarkers / Q000097:blood; D001798:Blood Proteins; D016022:Case-Control Studies; D017115:Catheter Ablation; D000066491:Clinical Decision-Making; D024042:Collagen Type I / Q000097:blood*; D022062:Electrophysiologic Techniques, Cardiac; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D000089703:Fibroblast Growth Factor-23; D005346:Fibroblast Growth Factors / Q000097:blood*; D005355:Fibrosis; D037502:Galectin 3 / Q000097:blood*; D037161:Galectins; D006325:Heart Atria / Q000378:metabolism* / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D010446:Peptide Fragments / Q000097:blood*; D010455:Peptides / Q000097:blood*; D011237:Predictive Value of Tests; D011347:Procollagen / Q000097:blood*; D016896:Treatment Outcome; D016277:Ventricular Function, Left
D015415:Biomarkers; D001798:Blood Proteins; D024042:Collagen Type I; C000717427:FGF23 protein, human; D037502:Galectin 3; D037161:Galectins; C428445:LGALS3 protein, human; D010446:Peptide Fragments; D010455:Peptides; D011347:Procollagen; C052929:collagen type I trimeric cross-linked peptide; C041876:procollagen Type III-N-terminal peptide; D005346:Fibroblast Growth Factors; D000089703:Fibroblast Growth Factor-23
Ablation; Atrial fibrillation; Biomarker; Fibrosis