Evaluating Serum Heat Shock Protein Levels as Novel Biomarkers for Atrial Fibrillation

Abstract

Background: Staging of atrial fibrillation (AF) is essential to understanding disease progression and the accompanied increase in therapy failure. Blood-based heat shock protein (HSP) levels may enable staging of AF and the identification of patients with higher risk for AF recurrence after treatment. Objective: This study evaluates the relationship between serum HSP levels, presence of AF, AF stage and AF recurrence following electrocardioversion (ECV) or pulmonary vein isolation (PVI). Methods: To determine HSP27, HSP70, cardiovascular (cv)HSP and HSP60 levels, serum samples were collected from control patients without AF and patients with paroxysmal atrial fibrillation (PAF), persistent (PeAF) and longstanding persistent (LSPeAF) AF, presenting for ECV or PVI, prior to intervention and at 3-, 6- and 12-months post-PVI. Results: The study population (n = 297) consisted of 98 control and 199 AF patients admitted for ECV (n = 98) or PVI (n = 101). HSP27, HSP70, cvHSP and HSP60 serum levels did not differ between patients without or with PAF, PeAF or LSPeAF. Additionally, baseline HSP levels did not correlate with AF recurrence after ECV or PVI. However, in AF patients with AF recurrence, HSP27 levels were significantly elevated post-PVI relative to baseline, compared to patients without recurrence. Conclusions: No association was observed between baseline HSP levels and the presence of AF, AF stage or AF recurrence. However, HSP27 levels were increased in serum samples of patients with AF recurrence within one year after PVI, suggesting that HSP27 levels may predict recurrence of AF after ablative therapy.

Atrial heat shock protein levels are associated with early postoperative and persistence of atrial fibrillation

“…Previous studies revealed an increase in HSPB1 levels 24 and HSPA1 levels 21 in follow-up serum samples of patients who developed AF recurrence post-ablative therapy. Such an increase in HSPs in follow-up serum samples was not observed in the current study, which may be due to presence of underlying heart diseases.…”

“…However, Cao, et al 23 described that patients undergoing mitral valve replacement with AF revealed higher plasma HSPD1 levels compared to patients in sinus rhythm. No previous studies, except for our recent study 24 , investigated serum HSPB7 as a marker to stage AF.…”

Cardioprotective Role of Heat Shock Proteins in Atrial Fibrillation: From Mechanism of Action to Therapeutic and Diagnostic Target

“…This trial investigated whether HSP levels in serum discriminate between control and the various stages of AF and predict AF recurrence after treatment. Importantly, serum HSPA1, HSPB1, HSPB7, and HSPD1 levels did not discriminate between the presence or stage of AF, nor did it identify patients at risk of AF recurrence after electrical cardioversion or pulmonary vein ablation [ 17 ]. However, follow-up serum HSPB1 levels predict AF recurrence in patients undergoing ablative therapy.…”

“…However, follow-up serum HSPB1 levels predict AF recurrence in patients undergoing ablative therapy. Here, serum HSPB1 levels significantly increased at 3, 6, and 12 months post-ablation compared with patients without AF recurrence within 1 year post-ablation [ 17 ]. These results suggest that HSPB1 levels may be useful in predicting recurrence of AF after ablative therapy.…”

“…Structural damage includes loss of sarcomeres and myofibrils (myolysis), disruption of mitochondria, and DNA damage [ 14 , 15 , 16 ]. Deterioration of the cardiomyocytes explains AF progression and the high number of AF recurrence after treatment [ 17 ].…”