Serum Amyloid A and C-Reactive Protein Independently Predict the Recurrences of Atrial Fibrillation After Cardioversion in Patients With Preserved Left Ventricular Function

Alessandra Barassi, Raffaele Pezzilli, Antonio M. Morselli-Labate, Federico Lombardi, Sebastiano Belletti, Giada Dogliotti, Massimiliano M. Corsi, Giampaolo Merlini, Gian Vico Melzi D'Eril

Research output: Contribution to journalArticle

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Abstract

Background: Subclinical inflammation and atrial stretch have been recognized as important contributors to atrial fibrillation (AF) onset and perpetuation. The aim of the study was to compare the predictive role of serum inflammatory markers (serum amyloid A [SAA], and C-reactive protein [CRP]) and N-terminal pro brain natriuretic peptide (NT-proBNP) an indice of atrial strain in relation to subacute arrhythmic recurrence rate in patients with persistent AF and normal left ventricular ejection fraction (LVEF). Methods: We studied 57 patients with a mean LVEF of 58.7 ± 6%. NT-proBNP, SAA and CRP levels were determined few hours before electrical cardioversion and 3 weeks after cardioversion. Results: Subacute AF recurrences were documented in 19 (33 %) patients. Whereas NT-proBNP levels did not predict arrhythmic outcome, higher SAA (> 6.16-6.19 mg/L) and CRP levels (> 2.99-3.10 mg/L) were significantly associated with AF recurrences (odds ratio [OR], 5.39; 95% confidence interval [CI], 1.59-18.26; P = 0.007 and OR, 14.93; 95% CI, 3.90-57.19; P <0.001). Both SAA (OR, 18.29; 95% CI, 2.07-161.46; P = 0.009) and high sensitivity CRP (OR, 42.03; 95% CI, 4.83-365.45; P = 0.001) through the multivariate logistic regression analysis show an independent role in predicting the AF recurrence with a sensitivity of 100% (38/38) and a specificity of 52.6% (10/19). Conclusions: The present study demonstrates that in patients with persistent AF and preserved LVEF, SAA and CRP levels are independent predictors of AF subacute recurrence rate, whereas NT-proBNP, not associated with arrhythmic outcome, reflects the hemodynamic alterations secondary to arrhythmia presence. The simultaneous determination of SAA and high sensitivity CRP has a very high sensitivity (100%) in predicting the AF recurrence.

Original languageEnglish
Pages (from-to)537-541
Number of pages5
JournalCanadian Journal of Cardiology
Volume28
Issue number5
DOIs
Publication statusPublished - Sep 2012

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Serum Amyloid A Protein
Electric Countershock
Left Ventricular Function
C-Reactive Protein
Atrial Fibrillation
Recurrence
Brain Natriuretic Peptide
Odds Ratio
Stroke Volume
Confidence Intervals
Cardiac Arrhythmias
Biomarkers
Logistic Models
Hemodynamics
Regression Analysis
Inflammation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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Serum Amyloid A and C-Reactive Protein Independently Predict the Recurrences of Atrial Fibrillation After Cardioversion in Patients With Preserved Left Ventricular Function. / Barassi, Alessandra; Pezzilli, Raffaele; Morselli-Labate, Antonio M.; Lombardi, Federico; Belletti, Sebastiano; Dogliotti, Giada; Corsi, Massimiliano M.; Merlini, Giampaolo; Melzi D'Eril, Gian Vico.

In: Canadian Journal of Cardiology, Vol. 28, No. 5, 09.2012, p. 537-541.

Research output: Contribution to journalArticle

Barassi, Alessandra ; Pezzilli, Raffaele ; Morselli-Labate, Antonio M. ; Lombardi, Federico ; Belletti, Sebastiano ; Dogliotti, Giada ; Corsi, Massimiliano M. ; Merlini, Giampaolo ; Melzi D'Eril, Gian Vico. / Serum Amyloid A and C-Reactive Protein Independently Predict the Recurrences of Atrial Fibrillation After Cardioversion in Patients With Preserved Left Ventricular Function. In: Canadian Journal of Cardiology. 2012 ; Vol. 28, No. 5. pp. 537-541.
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abstract = "Background: Subclinical inflammation and atrial stretch have been recognized as important contributors to atrial fibrillation (AF) onset and perpetuation. The aim of the study was to compare the predictive role of serum inflammatory markers (serum amyloid A [SAA], and C-reactive protein [CRP]) and N-terminal pro brain natriuretic peptide (NT-proBNP) an indice of atrial strain in relation to subacute arrhythmic recurrence rate in patients with persistent AF and normal left ventricular ejection fraction (LVEF). Methods: We studied 57 patients with a mean LVEF of 58.7 ± 6{\%}. NT-proBNP, SAA and CRP levels were determined few hours before electrical cardioversion and 3 weeks after cardioversion. Results: Subacute AF recurrences were documented in 19 (33 {\%}) patients. Whereas NT-proBNP levels did not predict arrhythmic outcome, higher SAA (> 6.16-6.19 mg/L) and CRP levels (> 2.99-3.10 mg/L) were significantly associated with AF recurrences (odds ratio [OR], 5.39; 95{\%} confidence interval [CI], 1.59-18.26; P = 0.007 and OR, 14.93; 95{\%} CI, 3.90-57.19; P <0.001). Both SAA (OR, 18.29; 95{\%} CI, 2.07-161.46; P = 0.009) and high sensitivity CRP (OR, 42.03; 95{\%} CI, 4.83-365.45; P = 0.001) through the multivariate logistic regression analysis show an independent role in predicting the AF recurrence with a sensitivity of 100{\%} (38/38) and a specificity of 52.6{\%} (10/19). Conclusions: The present study demonstrates that in patients with persistent AF and preserved LVEF, SAA and CRP levels are independent predictors of AF subacute recurrence rate, whereas NT-proBNP, not associated with arrhythmic outcome, reflects the hemodynamic alterations secondary to arrhythmia presence. The simultaneous determination of SAA and high sensitivity CRP has a very high sensitivity (100{\%}) in predicting the AF recurrence.",
author = "Alessandra Barassi and Raffaele Pezzilli and Morselli-Labate, {Antonio M.} and Federico Lombardi and Sebastiano Belletti and Giada Dogliotti and Corsi, {Massimiliano M.} and Giampaolo Merlini and {Melzi D'Eril}, {Gian Vico}",
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AU - Barassi, Alessandra

AU - Pezzilli, Raffaele

AU - Morselli-Labate, Antonio M.

AU - Lombardi, Federico

AU - Belletti, Sebastiano

AU - Dogliotti, Giada

AU - Corsi, Massimiliano M.

AU - Merlini, Giampaolo

AU - Melzi D'Eril, Gian Vico

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N2 - Background: Subclinical inflammation and atrial stretch have been recognized as important contributors to atrial fibrillation (AF) onset and perpetuation. The aim of the study was to compare the predictive role of serum inflammatory markers (serum amyloid A [SAA], and C-reactive protein [CRP]) and N-terminal pro brain natriuretic peptide (NT-proBNP) an indice of atrial strain in relation to subacute arrhythmic recurrence rate in patients with persistent AF and normal left ventricular ejection fraction (LVEF). Methods: We studied 57 patients with a mean LVEF of 58.7 ± 6%. NT-proBNP, SAA and CRP levels were determined few hours before electrical cardioversion and 3 weeks after cardioversion. Results: Subacute AF recurrences were documented in 19 (33 %) patients. Whereas NT-proBNP levels did not predict arrhythmic outcome, higher SAA (> 6.16-6.19 mg/L) and CRP levels (> 2.99-3.10 mg/L) were significantly associated with AF recurrences (odds ratio [OR], 5.39; 95% confidence interval [CI], 1.59-18.26; P = 0.007 and OR, 14.93; 95% CI, 3.90-57.19; P <0.001). Both SAA (OR, 18.29; 95% CI, 2.07-161.46; P = 0.009) and high sensitivity CRP (OR, 42.03; 95% CI, 4.83-365.45; P = 0.001) through the multivariate logistic regression analysis show an independent role in predicting the AF recurrence with a sensitivity of 100% (38/38) and a specificity of 52.6% (10/19). Conclusions: The present study demonstrates that in patients with persistent AF and preserved LVEF, SAA and CRP levels are independent predictors of AF subacute recurrence rate, whereas NT-proBNP, not associated with arrhythmic outcome, reflects the hemodynamic alterations secondary to arrhythmia presence. The simultaneous determination of SAA and high sensitivity CRP has a very high sensitivity (100%) in predicting the AF recurrence.

AB - Background: Subclinical inflammation and atrial stretch have been recognized as important contributors to atrial fibrillation (AF) onset and perpetuation. The aim of the study was to compare the predictive role of serum inflammatory markers (serum amyloid A [SAA], and C-reactive protein [CRP]) and N-terminal pro brain natriuretic peptide (NT-proBNP) an indice of atrial strain in relation to subacute arrhythmic recurrence rate in patients with persistent AF and normal left ventricular ejection fraction (LVEF). Methods: We studied 57 patients with a mean LVEF of 58.7 ± 6%. NT-proBNP, SAA and CRP levels were determined few hours before electrical cardioversion and 3 weeks after cardioversion. Results: Subacute AF recurrences were documented in 19 (33 %) patients. Whereas NT-proBNP levels did not predict arrhythmic outcome, higher SAA (> 6.16-6.19 mg/L) and CRP levels (> 2.99-3.10 mg/L) were significantly associated with AF recurrences (odds ratio [OR], 5.39; 95% confidence interval [CI], 1.59-18.26; P = 0.007 and OR, 14.93; 95% CI, 3.90-57.19; P <0.001). Both SAA (OR, 18.29; 95% CI, 2.07-161.46; P = 0.009) and high sensitivity CRP (OR, 42.03; 95% CI, 4.83-365.45; P = 0.001) through the multivariate logistic regression analysis show an independent role in predicting the AF recurrence with a sensitivity of 100% (38/38) and a specificity of 52.6% (10/19). Conclusions: The present study demonstrates that in patients with persistent AF and preserved LVEF, SAA and CRP levels are independent predictors of AF subacute recurrence rate, whereas NT-proBNP, not associated with arrhythmic outcome, reflects the hemodynamic alterations secondary to arrhythmia presence. The simultaneous determination of SAA and high sensitivity CRP has a very high sensitivity (100%) in predicting the AF recurrence.

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