CHA2DS2-VASc score and blood biomarkers to identify patients with atrial high-rate episodes and paroxysmal atrial fibrillation

• Published in: Europace (London, England) England), 2017-04, Vol.19 (4), p.544-551
• Main Authors: Wakula, Paulina, Neumann, Benjamin, Kienemund, Jens, Thon-Gutschi, Eva, Stojakovic, Tatjana, Manninger, Martin, Scherr, Daniel, Scharnagl, Hubert, Kapl, Martin, Pieske, Burkert, Heinzel, Frank R
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Atrial Fibrillation - blood; Atrial Fibrillation - diagnosis; Atrial Fibrillation - epidemiology; Atrial Natriuretic Factor - blood; Biomarkers - blood; Causality; Comorbidity; Electrocardiography - statistics & numerical data; Female; Germany - epidemiology; Humans; Incidence; Interleukin-6 - blood; Male; Natriuretic Peptide, Brain - blood; Peptide Fragments - blood; Reproducibility of Results; Risk Assessment - methods; Sensitivity and Specificity; Serum Amyloid A Protein - analysis; Stroke - blood; Stroke - diagnosis; Stroke - epidemiology; Tissue Inhibitor of Metalloproteinase-4; Tissue Inhibitor of Metalloproteinases - blood
• ISSN: 1532-2092
• DOI: 10.1093/europace/euw101

Paroxysmal atrial fibrillation (PAF) is often asymptomatic but nonetheless harmful. We evaluated the performance of disease-related blood biomarkers and CHA2DS2-VASc score to discriminate for PAF in patients with continuous rhythm monitoring. Clinical data and blood samples were obtained from patients with dual-chamber pacemakers selected according to the absence (no_AHRE) or presence of Atrial High-Rate Episodes (AHRE) >6 min in recent device history (case-control approach). We included 93 patients (n = 49 AHRE, n = 44 no_AHRE). In a subgroup with high AHRE burden and confirmed PAF 15 biomarkers were evaluated (n = 19 AHRE-AF vs. n = 20 no_AHRE). Significantly regulated biomarkers were then tested in all patients to distinguish no_AHRE from AHRE (receiver operating characteristics analysis). Hsp27, TGFβ1, cystatin C, matrix metalloproteinases MMP-2,-3,-9, albumin, and serum uric acid were not altered in the subgroup. Tissue inhibitors of metalloproteinases (TIMP) -1,-2,-4; NT-proANP, NT-proBNP, IL-6 and serum amyloid protein A were significantly different in AHRE vs. no_AHRE (subgroup and whole cohort), with best discriminatory performance for TIMP-4. Biomarkers performed better than CHADS2-VASc for AHRE discrimination. Intracardial electrograms and medical history from seven AHRE patients suggested atrial tachycardia and not AF (AHRE-AT). Four of the most relevant regulated biomarkers (TIMP-4, TIMP-2, SAA, NT-proBNP) behaved similarly in AHRE-AT and AHRE-AF. NT-proBNP >150 pg/mL indicated an odds ratio of 12.9 for AHRE. Combining two biomarkers significantly improved discrimination of AHRE. TIMP-4, NT-proANP, NT-proBNP were strongest associated with PAF and AHRE. The discriminatory performance of CHADS2-VASc for PAF was increased by addition of selected biomarkers.