Are the atrial natriuretic peptides a missing link predicting low‐voltage areas in atrial fibrillation? Introducing the novel biomarker‐based atrial fibrillation substrate prediction (ANP) score

Abstract

Background In patients with atrial fibrillation (AF), left atrial (LA) enlargement, and the presence of low‐voltage areas (LVAs) indicate an advanced disease stage. NT‐proANP is a biomarker, which is significantly higher in both phenotypes. Prediction of LVAs before catheter ablation could impact the prognosis and therapeutical management in AF patients. Objective The aim of this study was to (a) analyze the predictive value of a novel biomarker‐based AF substrate prediction score, and (b) compare it with DR‐FLASH and APPLE scores. Methods Patients undergoing first AF catheter ablation were included. LA volume (LAV) was analyzed prior to ablation using cardiovascular magnetic resonance imaging (CMR). Blood plasma samples from the femoral vein were collected before AF ablation. NT‐proANP was analyzed using commercially available assays. LVAs were determined using high‐density maps during catheter ablation and defined as <0.5 mV. The novel ANP score (one point for A ge ≥ 65 years, N T‐proANP > 17 ng/mL, and P ersistent AF) was calculated at baseline. Results The study population included 156 AF patients (64 ± 10 years, 65% males, 61% persistent AF, 28% LVAs). The cut‐off ANP score ≥ 2 demonstrated 77% sensitivity and 70% specificity. On logistic regression (odds ratio [OR] 3.469) and receiver operating characteristic (ROC) analysis (area under the curve [AUC] 0.778, P < .001), the ANP score significantly predicted LVAs presence. There were no differences between novel ANP score – which is a new one ‐ is described in the Abstract; with APPLE (AUC 0.718, P = .378) and DR‐FLASH (AUC 0.766, P = .856) scores. Conclusions The novel biomarker‐based ANP score demonstrates good prediction of LVAs.

The predictive value of galectin‐3 levels on left atrial low voltage areas assessed by high‐density mapping in patients with paroxysmal atrial fibrillation

“…In the study by Kornej et al, troponin T levels were found to be significantly higher in paroxysmal AF and persistent AF patients with LVA than in those without LVA, and persistent AF, LA size, and troponin T levels were found to be a significant predictor for the presence of LVA 24 . In another study, the novel ANP score (one point for age ≥65 years, NT‐proANP over 75th percentile in peripheral circulation [17 ng/ml] and persistent AF type) ≥2 demonstrated good sensitivity and specificity for the LVAs presence (72% and 70%, respectively) 25 . The study by Yalcın et al, in which LA fibrosis areas were evaluated with delayed‐enhancement cardiac MRI, showed a significant correlation between serum galectin‐3 levels and the extent of left atrial fibrosis 26 .…”

Novel diagnostic criteria for atrial cardiomyopathy in patients with type 2 diabetes and atrial fibrillation

“…Эти противоречия связаны с тем, что более ранними проявлениями ПКМП без изменений размеров и объемов предсердий могут быть электрофизиологические предсердные нарушения, выявляемые при вольтажном картировании в виде зон низкого вольтажа, которые отражают наличие полей периваскулярного фиброза без растяжения миокардиальных волокон и, соответственно, без увеличения концентрации НУП в крови [15]. Но даже в диапазоне нормальных значений, как и в нашем исследовании, предсердные НУП являются статистически значимыми предикторами фиброза предсердий, определяемого при вольтажном картировании [16].…”

Innovations and paradigm shifts in atrial fibrillation ablation

“…26 Biomarkers, like NT-proANP, have been incorporated in risk scores as well and have demonstrated good prediction of low voltage areas. 27 Moreover, additional imaging of the left atrium may be used to assess the left atrial substrate. An interesting study in this field was the Delayed-Enhancement MRI Determinant of Successful Radiofrequency Catheter Ablation of Atrial Fibrillation (DECAAF) trial.…”