Comparison of systemic inflammation activity and patients immune status in patients with various forms of atrial fibrillation and flutter

Abstract

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): National Scientific Centre "M. D. Strazhesko Institute of Cardiology" Aims The inflammatory theory of atrial fibrillation and flutter arrhythmogenesis has attracted researcher`s attention in recent years, so the aim of our work is to compare the immune status of patients and systemic inflammation in paroxysmal and persistent atrial fibrillation and flutter in hypertensive people. Materials and methods The study involved 103 patients with hypertension and arrhythmias, who were divided into three main groups: group 1 (n = 35) - with paroxysmal atrial fibrillation (AF), group 2 (n = 38) - with persistent form of AF, group 3 (n = 30) - with persistent form of atrial flutter (AFl). For comparison, 2 control groups were formed: 4 (n = 23) - patients with hypertension, but without a history of arrhythmias and 5 (n = 21) - almost healthy people. The immune status of these patients was assessed by determining the level of monocytes (Mc), lymphocytes subpopulations and T-regulatory cells (T-reg) in the peripheral blood using flow cytometry. The activity of systemic inflammation was determined by serum highly specific C-reactive protein (CRP) level. Results It was noted that he number of classical CD14++CD16- and intermediate CD14++CD16+ Mc was significantly higher in patients with persistent AF and AFl comparing with patients without arrhythmias and healthy people (p<0.005). This fraction of Mc is able to produce proinflammatory cytokines and activate the local renin-angiotensin system, thus triggering the processes of fibrosis in the myocardium. Amount of non-classical CD14+CD16++ Mc was significantly lower in the second group both quantitatively and in percentage (p<0.005). The count of T cells with natural killer (TNK) activity was higher in all groups comparing to normal value, so statistical significance was observed only in comparison with the fifth group. The highest quantity of T-reg cells was found in healthy people comparing to other groups and a strong mathematical significance was obtained in all cases (p <0.005), both comparing the values in percentage and in μl. Patients with cardiac arrhythmias had signs of active systemic inflammation, such as high level of highly specific CRP. The highest one was in 2 group and exceeded the normal level by 6.7 times (8.31 ± 0.42) versus 1.25 ± 0.01) mg per l (p <0.001). Conclusions Patients with AF and AFl on the hypertension background comparing to hypertensive patients without arrhythmias or healthy people have a higher intensity of systemic inflammation because of higher levels of highly specific CRP, increased activity of proinflammatory subpopulation of monocytes, higher amount of T-cells with natural killer activity and reduced T-regulatory cells, whose main function is to control the immune response.