Characterisation and validity of inflammatory biomarkers in the prediction of post-operative atrial fibrillation in coronary artery disease patients

Diana Kaireviciute; Andrew D. Blann; Balu Balakrishnan; Deirdre A. Lane; Jeetesh V. Patel; Giedrius Uzdavinys; Gediminas Norkunas; Gintaras Kalinauskas; Vytautas Sirvydis; Audrius Aidietis; Gregory Y. H. Lip

doi:10.1160/TH09-12-0837

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2010; 104(01): 122-127
DOI: 10.1160/TH09-12-0837

Cardiovascular Biology and Cell Signalling

Schattauer GmbH

Characterisation and validity of inflammatory biomarkers in the prediction of post-operative atrial fibrillation in coronary artery disease patients

Diana Kaireviciute

¹Haemostasis, Thrombosis, and Vascular Biology Unit, University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom

²Vilnius University Hospital Santariskiu Klinikos, Vilnius, Lithuania

,

Andrew D. Blann

¹Haemostasis, Thrombosis, and Vascular Biology Unit, University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom

,

Balu Balakrishnan

¹Haemostasis, Thrombosis, and Vascular Biology Unit, University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom

,

Deirdre A. Lane

¹Haemostasis, Thrombosis, and Vascular Biology Unit, University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom

,

Jeetesh V. Patel

¹Haemostasis, Thrombosis, and Vascular Biology Unit, University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom

,

Giedrius Uzdavinys

²Vilnius University Hospital Santariskiu Klinikos, Vilnius, Lithuania

³University of Vilnius, Vilnius, Lithuania

,

Gediminas Norkunas

²Vilnius University Hospital Santariskiu Klinikos, Vilnius, Lithuania

³University of Vilnius, Vilnius, Lithuania

,

Gintaras Kalinauskas

²Vilnius University Hospital Santariskiu Klinikos, Vilnius, Lithuania

³University of Vilnius, Vilnius, Lithuania

,

Vytautas Sirvydis

²Vilnius University Hospital Santariskiu Klinikos, Vilnius, Lithuania

³University of Vilnius, Vilnius, Lithuania

,

Audrius Aidietis

²Vilnius University Hospital Santariskiu Klinikos, Vilnius, Lithuania

³University of Vilnius, Vilnius, Lithuania

,

Gregory Y. H. Lip

¹Haemostasis, Thrombosis, and Vascular Biology Unit, University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom

› Author Affiliations

Abstract

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Summary

Atrial fibrillation (AF) is a common complication of coronary artery bypass grafting (CABG). We sought to determine the diagnostic validity of plasma biomarkers of i) inflammation (marked by interleukin-6 [IL-6] and high-sensitivity C-reactive protein [hs-CRP]), ii) extracellular matrix remodelling (matrix metalloproteinase [MMP-9], tissue inhibitor of matrix metalloproteinase [TIMP-1]) and iii) the prothrombotic state (tissue factor and von Willebrand factor [vWF]) in the risk prediction of post-operative AF. Samples were obtained preoperatively from peripheral/femoral vein and from intracardiac chambers (right atrium [RA], the right atrial appendage [RAA], the left atrium [LA] and the left atrial appendage [LAA]) amongst 100 consecutive patients free of AF and inflammatory disease undergoing elective CABG. Biomarker concentrations were related to incident AF (30 days). At 30 days post CABG, 30 patients were proven to have had AF. Concentrations of tissue factor (TF) and vWF were unrelated to postoperative AF. Peripheral (p=0.018), and intracardiac levels (RAA (p=0.029) and LA (p=0.026)) of hs-CRP were associated with the presence of AF after CABG. Intracardiac levels of IL-6 in samples from the RAA (p=0.031), LA (p=0.042) and LAA (p=0.006), and MMP-9 in the LAA sample were also associated with AF (p=0.007). Our data suggest that an intra-cardiac inflammatory environment that is manifest peri-operatively may predispose to the development of post-operative AF. This intracardiac inflammatory state was reflected by increased peripheral hs-CRP levels. These differences may indicate local substrate abnormalities contributing to the development of AF post-operatively.

Keywords

Atrial fibrillation - inflammation - prothrombotic state - remodeling - cardiac surgery

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References

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