Final+manuscript.pdf (2.31 MB)
Download file

Comparing biomarker profiles of patients with heart failure: atrial fibrillation vs. sinus rhythm and reduced vs. preserved ejection fraction.

Download (2.31 MB)
journal contribution
posted on 07.09.2018, 15:28 by Bernadet T. Santema, Mariëlle Kloosterman, Isabelle C. Van Gelder, Ify Mordi, Chim C. Lang, Carolyn S. P. Lam, Stefan D. Anker, John G. Cleland, Kenneth Dickstein, Gerasimos Filippatos, Pim Van der Harst, Hans L. Hillege, Jozine M. Ter Maaten, Marco Metra, Leong L. Ng, Piotr Ponikowski, Nilesh J. Samani, Dirk J. Van Veldhuisen, Aeilko H. Zwinderman, Faiez Zannad, Kevin Damman, Peter Van der Meer, Michiel Rienstra, Adriaan A. Voors
Aims: The clinical correlates and consequences of atrial fibrillation (AF) might be different between heart failure with reduced vs. preserved ejection fraction (HFrEF vs. HFpEF). Biomarkers may provide insights into underlying pathophysiological mechanisms of AF in these different heart failure (HF) phenotypes. Methods and results: We performed a retrospective analysis of the BIOlogy Study to TAilored Treatment in Chronic Heart Failure (BIOSTAT-CHF), which was an observational cohort. We studied 2152 patients with HFrEF [ejection fraction (EF < 40%)], of which 1419 were in sinus rhythm (SR) and 733 had AF. Another 524 patients with HFpEF (EF ≥50%) were studied, of which 286 in SR and 238 with AF. For the comparison of biomarker profiles, 92 cardiovascular risk markers were measured (Proseek® Olink Cardiovascular III panel). The circulating risk marker pattern observed in HFrEF was different than the pattern in HFpEF: in HFrEF, AF was associated with higher levels of 77 of 92 (84%) risk markers compared to SR; whereas in HFpEF, many more markers were higher in SR than in AF. Over a median follow-up of 21 months, AF was associated with increased mortality risk [multivariable hazard ratio (HR) of 1.27; 95% confidence interval (CI) 1.09-1.48, P = 0.002]; there was no significant interaction between heart rhythm and EF group on outcome. Conclusion: In patients with HFrEF, the presence of AF was associated with a homogeneously elevated cardiovascular risk marker profile. In contrast, in patients with HFpEF, the presence of AF was associated with a more scattered risk marker profile, suggesting differences in underlying pathophysiological mechanisms of AF in these HF phenotypes.

Funding

Netherlands Cardiovascular Research Initiative: an initiative with support of the Dutch Heart Foundation; Renal Connection to microvascular disease and heart failure with preserved ejection fraction (CVON2014-11 RECONNECT); and European Commission (FP7-242209-BIOSTAT-CHF; EudraCT 2010–020808–29); NHS Education for Scotland/Chief Scientist Office Postdoctoral Clinical Lectureship (PCL/17/07 to I.M.).

History

Citation

European Heart Journal, 2018, ehy421

Author affiliation

/Organisation/COLLEGE OF LIFE SCIENCES/School of Medicine/Department of Cardiovascular Sciences

Version

AM (Accepted Manuscript)

Published in

European Heart Journal

Publisher

Oxford University Press (OUP) for European Society of Cardiology

issn

0195-668X

eissn

1522-9645

Acceptance date

03/07/2018

Copyright date

2018

Available date

22/08/2019

Publisher version

https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehy421/5077588

Notes

The file associated with this record is under embargo until 12 months after publication, in accordance with the publisher's self-archiving policy. The full text may be available through the publisher links provided above.

Language

en