Associations Between Multiple Circulating Biomarkers and the Presence of Atrial Fibrillation in Hypertrophic Cardiomyopathy with or Without Left Ventricular Outflow Tract Obstruction

Abstract

Atrial fibrillation (AF) is the most common arrhythmia in patients with hypertrophic cardiomyopathy (HCM). Data regarding the correlations of biomarkers and AF in HCM patients are rather limited. We sought to explore the associations between the presence of AF and circulating biomarkers reflecting cardiovascular function (N-terminal pro-brain natriuretic peptide, NT-pro BNP), endothelial function (big endothelin-1, big ET-1), inflammation (high-sensitivity C-reactive protein), and myocardial damage (cardiac troponin I, cTnI) in HCM patients with and without left ventricular outflow tract obstruction (LVOTO).In all, 375 consecutive HCM in-hospital patients were divided into an AF group (n = 90) and a sinus rhythm (SR) group (n = 285) according to their medical history and electrocardiogram results.In comparison with the SR group, peripheral concentrations of big ET-1, NT-pro BNP, and cTnI were significantly higher in patients with AF. Only the biomarker of big ET-1, together with palpitation and left atrial diameter (LAD), was independently associated with AF in HCM patients. Ln big ET-1 was positively related to Ln NT-pro BNP, LAD, and heart rate, but negatively related to left ventricular ejection fraction. Combined measurements of big ET-1 !0.285 pmol/L and LAD !44.5 mm indicated good predictive values in the presence of AF, with a specificity of 94% and a sensitivity of 85% in HCM patients.Big ET-1 has been identified as an independent determinant of AF, regardless of LVOTO, and is significantly related to parameters representing cardiac function and remodeling in HCM. Big ET-1 might be a valuable index to evaluate the clinical status of AF in HCM patients. (Int Heart J 2019; 60: 327-335)

Pericardial NT-Pro-BNP and GDF-15 as Biomarkers of Atrial Fibrillation and Atrial Matrix Remodeling in Aortic Stenosis

“…This biomarker has been reported to increase in AF, although studies in aortic stenosis are lacking [32]. Liu et al found that AF in hypertrophic cardiomyopathy was associated with higher values of NT-pro-BNP in serum [9]. Herein, this biomarker was increased when AF was present, both in serum and pericardial fluid, with the latter having a more robust association.…”

“…Moreover, other biomarkers, such as NT-pro-B-type natriuretic peptide (NT-pro-BNP), have been consistently associated with atrial fibrillation [6,9]. NT-pro-BNP predicts mortality in valvular disease, including aortic stenosis, although the role in atrial fibrillation in this subset of patients remains unclear [10].…”

The Expression of BNP, ET-1, and TGF-β1 in Myocardium of Rats with Ventricular Arrhythmias

“…ET-1 is the most potent vasoconstrictor in the human cardiovascular system and has remarkably long-lasting actions [32]. It contributes to a reduction in cardiac output, the stimulation of cardiac hypertrophy, and fibroblast proliferation by activating two G-protein–coupled receptors: endothelin receptor type A (ETA) and endothelin receptor type B (ETB) [13]. Moreover, ET-1 is capable of hindering local electrocardio-conduction and thus modulating arrhythmia [12,33,34,35].…”

“…Clinical studies have shown that cardiomyocytes can synthesize and secrete BNP during VA and that BNP in plasma has a very high predictive value for the occurrence of arrhythmias in patients with congestive heart failure (CHF) [10,11]. ET-1 is a potent coronary vasoconstrictor that plays an active role in arrhythmogenesis [12,13]. Vitro experiments have shown that mechanical stress also acts on cardiomyocytes.…”

Endothelin-1 and Atrial Cardiomyopathy

“…Liu, et al 3) reported a correlation between big endothelin-1 (ET-1) and biomarkers for cardiac stress, such as NT-ProBNP and cardiac troponin I. Big ET-1 is a 38-amino acid precursor of ET-1 with a longer half-life than ET-1.…”