Abstract 2556: Differential Predictive Value of Biomarkers for Atrial Fibrillation-related Mortality and Vascular Events: A Prospective Study
Introduction: Biomarkers of inflammation, remodeling or endothelial activation are associated with vascular events (VE) in atrial fibrillation (AF) patients (pts). A comparison of predictive value of such biomarkers has not been prospectively performed.
Methods: Consecutive patients (n=308) with AF were screened for participation. Pts with active inflammation or malignancy were excluded. A total of 278 pts (mean age 70±11, 63% male) were followed-up at 6 months intervals. Primary endpoint (P.EP) was composite of total mortality and VE (stroke, TIA, peripheral embolism, myocardial infarction). Total mortality was secondary EP (S.EP). Plasma samples were obtained at initial visits for ELISA assessment of circulating biomarker levels (endothelial activation: sVCAM-1, vWF; structural atrial remodeling: MMP-2; inflammation: hsCRP, sCD40-L).
Results: During a mean follow-up of 17±9 months, 55 pts died and 32 had AF-related VE. With univariate analysis age, CHADS2 score, vWF and sVCAM-1 were associated with the P.EP while upon multivariate Cox-regression analysis only increased sVCAM-1 was independently associated (HR=1.93, 95%CI 1.06 –3.52, P=0.032). Beyond clinical parameters (age, CHADS2, LV function), vWF and sVCAM-1 were also associated with the S.EP. Among biomarkers only increased sVCAM-1 was independently associated with total mortality (HR=2.61, 95%CI 1.38 – 4.92, P=0.003). Mortality of those AF pts. exhibiting elevated sVCAM-1 levels was increased (Fig.⇓).
Conclusion: In this prospective study, initial determination of sVCAM-1 levels was superior to other markers of inflammation or endothelial activation for prediction of mortality and AF-related VE.