Growth differentiation factor-15 (GDF-15) is a stress-responsivememberofthetransforminggrowthfactor- βsuperfamilythatwasorig-inally cloned as a macrophage-inhibitory cytokine [1]. It rapidly in-creases following myocardial stretch, volume overload, oxidativestress and inflammatory state [2,3]. In recent years, it is emerging as anovel biomarker to predict mortality and adverse events in patientswith heart failure (HF) [4–7], acute coronary syndrome (ACS) [8–10]and acute pulmonary embolism [11]. Neuregulin-1 (NRG-1) is a mem-beroftheepidermalgrowthfactor(EGF)family[12]andplaysacriticalrole in cardiovascular development, cell survival, growth, and metabo-lism [13,14]. Recently, NRG-1 was shown to be a stress-related cardiacgrowth and angiogenic biomarker [15,16].Atrialfibrillation(AF)isthemostcommoncardiacarrhythmiaandisassociated with an increased risk of morbidity and mortality [17]. Therole of GDF-15 and NRG-1 in the setting of AF has not been studied.We soughttoinvestigate thepotentialrelationshipbetweencirculatingserum levels of GDF-15, NRG-1 and non-valvular AF.We enrolled 67 consecutive patients with paroxysmal AF and 67patientswithoutAFmatchedforsex,ageandatheroscleroticriskfactorspresenting to our institution between August 2012 and June 2013.Exclusioncriteriawerehistoryofmyocardialinfarction,ACS,congestiveHF, history of cardiac surgery, valvular heart disease, congenital heartdisease, cardiomyopathy, liver and kidney dysfunction, recent strokeor transient ischemic attack, inflammatory or neoplastic diseases, thy-roid disorder and anemia. The ethics committee of Second Hospital ofTianjin Medical University approved this study and written informedconsent was obtained from all patients enrolled.Baseline demographic and clinical characteristics were collected.Serumcreatinine(Cr),fastingblood-glucose(FBG),alanineaminotrans-ferase (ALT), and aspartate aminotransferase (AST) were measuredafter overnight fasting of 12 h with an automatic analyzer (TBA-120FR, Toshiba, Shenzhen, China). Blood samples were collected after supinerest for at least 10 min and overnight fasting of 12 h. The blood sampleswere then centrifuged for 15 min at 3500 r/min to obtain superna-tants which were stored at −80 °C until use. Serum levels of SOD andCAT were measured by colorimetry (Nanjing Jiancheng BioengineeringInstitute, China). Serum high-sensitivity C-reactive protein (hs-CRP)was measured using a high-sensitivity immmunonephelometric assay.Serum levels of NRG-1 and GDF-15 were assayed using commerciallyavailable ELISA kit (Cusabio Biotech Corporation, China). The kit has adetection range of 31.25 to 2000 pg/ml for GDF-15 with intra-assayand inter-assay variability of b8% and b10% respectively. The detectionrange for NRG-1 was 7.8 to 500 ng/ml with intra-assay and inter-assayvariability of b8% and b10% respectively. Transthoracic echocardio-graphicexaminationwasperformedusingtheVivid-7systemequippedwitha2.4 MHztransducer (GE Medical Systems, Milwaukee, WI,USA).Leftatrialdiameter(LAD), interventricularseptalwallthickness(IVST),left ventricular posterior wall thickness (LVPWT) and left ventricularend-diastolic diameter (LVEDD) were measured. Left ventricular ejec-tion fraction (LVEF) was determined from apical four-chamber andtwo-chamber views using Simpson's biplane formula.Categorical variables were reported as percentage and continuousvariables as means ± SD or median (interquartile range). Statisticalanalysis was performed using t-test or Kolmogorov–Smirnov test forcontinuousvariableswhiletheChisquaretestwasusedtocomparecat-egorical variables. Multivariable regressionanalyses were performed toinvestigate the relationship between GDF-15, NRG-1 and AF. A P valueof b0.05 was regarded as statistically significant. All tests were two-tailed and analyses were performed using SPSS 17.0 Statistical PackageProgram (SPSS Inc., Chicago, IL, USA).Clinical characteristics of study population are shown in Table 1.Patients with paroxysmal AF and controls had a similar distribution incardiovascular risk factors and medications. Baseline laboratory andechocardiographic characteristics of study population are shown inTable2.PatientswithAFhadhigherLAD, NRG-1andGDF-15comparedto non-AF patients. No significant difference in hs-CRP, SOD and CAT
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