Background Inflammation may play a significant role in the pathogenesis of atrial fibrillation (AF).
Objectives To examine the roles of three systemic inflammatory markers in predicting recurrent AF.
Methods The association between the plasma concentrations of high-sensitivity C reactive protein (hsCRP), interleukin-6 (IL-6) and pentraxin-3 (PTX3) with echocardiographic parameters and with the time to first recurrence of AF was tested in 382 patients with a history of AF but in sinus rhythm at randomisation, enrolled in the GISSI-AF biohumoral study.
Results Baseline PTX3 was related to left atrial, but not to left ventricular chamber volume. During one year of follow-up, 204 patients (53.1%) had a recurrent AF. There were no significant differences in baseline median [Q1–Q3] plasma concentrations of IL-6, hsCRP and PTX3 among patients with (2.11 [1.47–3.74] pg/ml, 3.30 [1.40–6.80] mg/l and 4.66 [3.27–6.97] ng/ml, respectively) or without recurrent AF (2.09 [1.37–2.90] pg/ml, p=0.182; 3.00 [1.10–6.20] mg/l, p=0.333; 5.09 [3.22–7.98] ng/ml, p=0.637). At 6 and 12 months follow-up, AF patients had significantly higher concentrations of IL-6 and PTX3 than those in sinus rhythm, and those with most recent episodes of AF had higher hsCRP. Baseline levels of IL-6, hsCRP or PTX3 were not significantly associated with a higher risk of recurrence of AF.
Conclusion In patients with a history of AF, but without significant left ventricular dysfunction or heart failure, inflammatory biomarkers may be raised but are, at best, weak predictors of the risk for first recurrence of AF.
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A complete list of the investigators who participated in the study is presented in the appendix.
Funding The GISSI studies and this substudy are supported by the Associazione Nazionale Medici Cardiologi Ospedalieri and by the Istituto di Ricerche Farmacologiche ‘Mario Negri’. The study is partially funded by a grant from the European Union Seventh Framework Programme, TOLERAGE (HEALTH-F4-2008-202156).
Competing interests SM, LS, APM, MGF, MD and RL received institutional research support from Novartis Pharma. FB is an employee of Novartis Pharma Italy, the company that funded the GISSI-AF trial. NM is an employee of Perseus Proteomics, which holds patent rights to the pentraxin-3 marker. Reagents for measuring circulating PTX3 were provided by Perseus Proteomics.
Ethics approval This study was conducted with the approval of the local ethics committees from the 36 Italian clinical centres that participated to the biomarkers substudy of the GISSI-AF trial.
Provenance and peer review Not commissioned; externally peer reviewed.
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