Abstract 452: Enhanced Soluble Cd40l As Predictor Of Vascular Events In Patients With Non-valvular Atrial Fibrillation: Results Of A Prospective Study.
Purpose - Atrial fibrillation (AF) is associated with an high incidence of vascular disease that may be related to a prothrombotic and inflammatory state. Soluble CD40 ligand (sCD40L), that stems essentially from platelet activation, possess inflammatory and prothrombotic properties. Aim of the study was to assess if sCD40L is a predictor of stroke and/or myocardial infarction(MI) in patients with non-valvular AF.
Methods - Plasma levels of sCD40L were measured in 231 patients [177 (77%) had permanent or persistent AF, and 54 (23%) had paroxysmal AF]. Patients were followed for a mean period of 27.8±8.8 months and cardiovascular events such as fatal and non fatal stroke and MI were recorded.
Results -AF population was divided in two groups patients according to sCD40L level above or below the median (4.76 m g/l). The two patients’ groups had similar distribution of cardiovascular risk factors, age, gender, medications or serum PCR levels. During the follow-up period, vascular events occurred in 6 (2 non-fatal MI and 4 non-fatal ischemic strokes) out of 116 patients with low levels of sCD40L (5.1%) and in 29 (11 fatal and 3 non-fatal MI; 3 fatal and 12 non-fatal ischemic strokes) out of 115 patients with high levels (25.2%) (log-rank test: p<0.001; Figure⇓). Using the COX proportional Hazards model, patients with sCD40L above the median were 4.63 times more likely to experience a vascular event (95% C.I.: 1.92–11.20).
Conclusions - This study shows that enhanced soluble CD40L level is predictor of vascular events in patients with non-valvular AF so suggesting that enhanced platelet activation may play an important role in its pathophisiology .