Comparing biomarker profiles of patients with heart failure: atrial fibrillation vs. sinus rhythm and reduced vs. preserved ejection fraction

Santema, B. T. et al. (2018) Comparing biomarker profiles of patients with heart failure: atrial fibrillation vs. sinus rhythm and reduced vs. preserved ejection fraction. European Heart Journal, 39(43), pp. 3867-3875. (doi: 10.1093/eurheartj/ehy421) (PMID:30137304)

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Abstract

Aims: The clinical correlates and consequences of atrial fibrillation (AF) might be different between heart failure with reduced vs. preserved ejection fraction (HFrEF vs. HFpEF). Biomarkers may provide insights into underlying pathophysiological mechanisms of AF in these different heart failure (HF) phenotypes. Methods and results: We performed a retrospective analysis of the BIOlogy Study to TAilored Treatment in Chronic Heart Failure (BIOSTAT-CHF), which was an observational cohort. We studied 2152 patients with HFrEF [ejection fraction (EF < 40%)], of which 1419 were in sinus rhythm (SR) and 733 had AF. Another 524 patients with HFpEF (EF ≥50%) were studied, of which 286 in SR and 238 with AF. For the comparison of biomarker profiles, 92 cardiovascular risk markers were measured (Proseek® Olink Cardiovascular III panel). The circulating risk marker pattern observed in HFrEF was different than the pattern in HFpEF: in HFrEF, AF was associated with higher levels of 77 of 92 (84%) risk markers compared to SR; whereas in HFpEF, many more markers were higher in SR than in AF. Over a median follow-up of 21 months, AF was associated with increased mortality risk [multivariable hazard ratio (HR) of 1.27; 95% confidence interval (CI) 1.09–1.48, P = 0.002]; there was no significant interaction between heart rhythm and EF group on outcome. Conclusion: In patients with HFrEF, the presence of AF was associated with a homogeneously elevated cardiovascular risk marker profile. In contrast, in patients with HFpEF, the presence of AF was associated with a more scattered risk marker profile, suggesting differences in underlying pathophysiological mechanisms of AF in these HF phenotypes.

Item Type:Articles
Additional Information:Funding: Netherlands Cardiovascular Research Initiative: an initiative with support of the Dutch Heart Foundation; Renal Connection to microvascular disease and heart failure with preserved ejection fraction (CVON2014-11 RECONNECT); and European Commission (FP7-242209-BIOSTAT-CHF; EudraCT 2010–020808–29); NHS Education for Scotland/Chief Scientist Office Postdoctoral Clinical Lectureship (PCL/17/07 to I.M.).
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Cleland, Professor John and Damman, Dr Kevin and Mordi, Dr Ify
Authors: Santema, B. T., Kloosterman, M., Van Gelder, I. C., Mordi, I., Lang, C. C., Lam, C. S.P., Anker, S., Cleland, J. G., Dickstein, K., Filippatos, G., van der Harst, P., Hillege, H. L., Ter Maaten, J. M., Metra, M., Ng, L. L., Ponikowski, P., Samani, N. J., Van Veldhuisen, D. J., Zwinderman, A. H., Zannad, F., Damman, K., van der Meer, P., Rienstra, M., and Voors, A. A.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Robertson Centre
Journal Name:European Heart Journal
Publisher:Oxford University Press
ISSN:0195-668X
ISSN (Online):1522-9645
Published Online:22 August 2018
Copyright Holders:Copyright © 2018 The Authors
First Published:First published in European Heart Journal 39(43): 3867-3875
Publisher Policy:Reproduced in accordance with the publisher copyright policy

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