Biomarkers and heart failure events in patients with atrial fibrillation in the ARISTOTLE trial evaluated by a multistate model

Aulin, J. et al. (2022) Biomarkers and heart failure events in patients with atrial fibrillation in the ARISTOTLE trial evaluated by a multistate model. American Heart Journal, 251, pp. 13-24. (doi: 10.1016/j.ahj.2022.03.009) (PMID:35569564)

Abstract

Background: Atrial fibrillation (AF) and heart failure (HF) often coexist. We investigated the prognostic impact of biomarkers on the development of HF and death in patients with AF and different left ventricular systolic function considering the influence of competing events. Methods: The study included 11,818 patients with AF from the ARISTOTLE trial who at entry had information on history of HF, an estimate of left ventricular function and plasma samples for determination of biomarkers representing cardiorenal dysfunction (NT-proBNP, troponin T, cystatin C) and inflammation (GDF-15, IL-6, CRP). Patients were categorized into: (I) HF with reduced ejection fraction (HFrEF, n=2,048), (II) HF with preserved ejection fraction (HFpEF, n=2,520), and (III) No HF (n=7,250). Biomarker associations with HF hospitalization and death were analyzed using a multi-state model accounting also for repeated events. Results: Baseline levels of NT-proBNP, troponin T, cystatin C, GDF-15, IL-6, and CRP were highest in HFrEF and lowest in No HF. During median 1.9 years follow-up, 546 patients were hospitalized at least once for HF and 819 died. Higher levels of all investigated biomarkers were associated with both outcomes (all p<0.0001), with highest event rates in HFrEF and lowest in No HF. The associations remained after adjustments and were more pronounced for first than for recurrent events. Conclusions: In anticoagulated patients with AF, biomarkers indicating cardiorenal dysfunction and inflammation improve the identification of patients at risk of developing HF or worsening of already existing HF. These biomarkers might be useful for targeting novel HF therapies in patients with AF.

• Item Type: Articles
• Additional Information: The ARISTOTLE trial was funded by Bristol-Myers Squibb, Co Princeton, NJ, USA, and Pfizer Inc., New York, NY, USA, and coordinated by the Duke Clinical Research Institute, Durham, NC, USA, and Uppsala Clinical Research Center, Uppsala, Sweden. This study was supported by the Swedish Foundation for Strategic Research (grant number RB13-0917).
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: McMurray, Professor John
• Authors: Aulin, J., Hijazi, Z., Lindbäck, J., Alexander, J. H., Gersh, B. J., Granger, C. B., Hanna, M., Horowitz, J., Lopes, R. D., McMurray, J. J.V., Oldgren, J., Siegbahn, A., and Wallentin, L.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
• Journal Name: American Heart Journal
• Publisher: Elsevier
• ISSN: 0002-8703
• ISSN (Online): 1097-6744
• Published Online: 13 May 2022
• Copyright Holders: Copyright © 2022 The Authors
• First Published: First published in American Heart Journal 251: 13-24
• Publisher Policy: Reproduced under a Creative Commons License