Abstract 2160: Role of Inflammatory Markers in the Prediction of First Recurrence of Atrial Fibrillation. Data from the GISSI-Atrial Fibrillation Trial
Inflammation may play a significant role in the pathogenesis and perpetuation of atrial fibrillation (AF). We aimed at evaluating the role of two systemic markers of inflammatory processes in recurrent AF in patients with a history of recent AF enrolled in a controlled clinical trial. Baseline plasma concentrations of C-reactive protein (CRP) and interleukin-6 (IL-6, high sensitive immunoassays) were measured in 382 patients enrolled in 36 centers participating to GISSI-AF, a prospective randomized study evaluating placebo-controlled valsartan treatment in patients with history of symptomatic AF and underlying cardiovascular comorbidities. The association between these biomarkers, clinical characteristics and outcome (adjudicated primary endpoint: time to first recurrence of AF) was tested by univariate Cox models. Patients were 62.8% males, 46.1% aged > 70 y, 11% with HF and/or depressed LVEF, 13.1% diabetics, 33.3% with SBP >140 mmHg. Baseline concentrations of IL-6 and CRP were 2.10 [1.41–3.35] pg/mL (median [Q1-Q3]) and 3.25 [1.10 – 6.70] mg/L, respectively. At univariate analysis, IL-6 and CRP were elevated in patients with HF and/or depressed LVEF; IL-6 was also higher in diabetics, females, patients >70 y, those with lone AF and dilated left atrium or with peripheral artery disease. During 1-y follow-up, 203 patients (53.1%) experienced first recurrence of AF. IL-6 and CRP plasma concentrations were similar in patients with (2.11 [1.47–3.74] pg/mL and 3.30 [1.40 – 6.80] mg/L, respectively) or without recurrent AF (2.09 [1.37–2.90] pg/mL, p=0.18 and 3.00 [1.10 – 6.20] mg/L, p=0.33). Above median concentrations of IL-6 or CRP were not significantly associated with the risk of first recurrence of AF (HR [95%CI] 1.07 [0.81–1.41] and 1.22 [0.92–1.61], by median levels). The plasma concentrations of two inflammatory markers, interleukin-6 and C-reactive protein were modestly elevated in this well-characterized population of patients with a history of recent AF and did not predict the risk for first recurrence of AF.