Abstract
Biomarkers may help to improve our knowledge about the complex pathophysiology of atrial fibrillation (AF). In this study we sought to identify significant changes in biomarkers and clinical measures in patients with and without AF recurrence after electrical cardioversion. We measured 21 conventional and new biomarkers before and 30 days after electrical cardioversion and assessed the associations of changes in biomarker levels with rhythm status at follow-up. Significant between-group changes were observed for bone morphogenetic protein 10 (BMP10), N-terminal pro-B-type natriuretic peptide (NT-proBNP) and total bilirubin. Their respective changes were − 10.4%, − 62.0% and − 25.6% in patients with sinus rhythm, and 3.1%, 1.1% and − 9.4% in patients with recurrent AF, for a between-group difference of − 13.5% (95% confidence interval [CI] − 19.3% to − 7.6%; P < 0.001), − 63.1% (95% CI − 76.6% to − 49.6%; P < 0.001) and − 16.3% (95% CI − 27.9% to − 4.7%; P = 0.007). In multivariable models, the reductions of BMP10 and NT-proBNP were significantly associated with follow-up rhythm status (β coefficient per 1 − SD decrease, − 3.85; 95% CI − 6.34 to − 1.35; P = 0.003 for BMP10 and − 5.84; 95% CI − 10.22 to − 1.47; P = 0.009 for NT-proBNP. In conclusion, changes in BMP10 und NT-proBNP levels were independently associated with rhythm status after cardioversion, suggesting that these markers may be dependent on the actual heart rhythm.
Highlights
Biomarkers may help to improve our knowledge about the complex pathophysiology of atrial fibrillation (AF)
None of the patients who had a reduction of both BMP10 and NT-proBNP levels below the respective median had an AF recurrence during follow-up (Table S6). In this prospective study of patients undergoing electrical cardioversion for persistent AF, patients who were in sinus rhythm after 30 days of follow-up had considerable reductions in BMP10 and NT-proBNP levels, whereas patients with AF recurrence had no significant change in these biomarker levels
The reductions of BMP10 and NT-proBNP remained significantly associated with rhythm status at follow-up after multivariable adjustment, suggesting that these biomarker changes may reflect the change in rhythm status itself, given that most other covariates and comorbidities remained unchanged during the short follow-up of 30 days
Summary
Biomarkers may help to improve our knowledge about the complex pathophysiology of atrial fibrillation (AF). We measured 21 conventional and new biomarkers before and 30 days after electrical cardioversion and assessed the associations of changes in biomarker levels with rhythm status at follow-up. Significant betweengroup changes were observed for bone morphogenetic protein 10 (BMP10), N-terminal pro-B-type natriuretic peptide (NT-proBNP) and total bilirubin. Their respective changes were − 10.4%, − 62.0% and − 25.6% in patients with sinus rhythm, and 3.1%, 1.1% and − 9.4% in patients with recurrent AF, for a between-group difference of − 13.5% (95% confidence interval [CI] − 19.3% to − 7.6%; P < 0.001), − 63.1% (95% CI − 76.6% to − 49.6%; P < 0.001) and − 16.3% (95% CI − 27.9% to − 4.7%; P = 0.007). The objective of our study was to assess the association of changes in biomarkers with changes in heart rhythm status among patients with persistent AF undergoing elective electrical cardioversion
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