C-Reactive protein elevation predicts the occurrence of atrial structural remodeling in patients with paroxysmal atrial fibrillation

Abstract

It has been poorly understood whether inflammation may contribute to atrial structural remodeling and increase the propensity for atrial fibrillation (AF) to persist. We investigated the relationship between C-reactive protein (CRP) elevation and the development of atrial remodeling in AF. The study population comprised 50 consecutive paroxysmal AF (PAF) patients and 50 control patients without AF. All patients underwent echocardiography, and high-sensitivity CRP was routinely measured. C-Reactive protein was significantly higher in the patients with PAF than control patients (0.231+/-0.176 mg/dl vs 0.055+/-0.041 mg/dl, P<0.001). Other predictors of elevated CRP included left ventricular mass (P<0.05), left ventricular end-systolic diameter (P<0.05), and left atrial (LA) diameter (P<0.001). In a multivariate analysis, only CRP and LA diameter were independent predictors of PAF. Elevated CRP levels correlated with LA diameter (r=0.489, P<0.001). Left atrial diameter was increased in PAF patients compared with control patients (P<0.001). We found that a longer duration of AF is associated with higher CRP levels and a larger LA diameter (duration <30 days: CRP 0.166+/-0.139 mg/dl, LA diameter 38.4+/-8.0 mm; duration >30 days: CRP 0.345+/-0.181 mg/dl, LA diameter 45.6+/-6.6 mm; P<0.001). In conclusion, longer AF duration is associated with CRP elevation and atrial structural remodeling, as approximated by larger LA diameter. However, CRP elevation, while correlating with LA diameter, was not an independent predictor of atrial structural remodeling. Thus, it remains unclear whether CRP and the inflammatory state are contributory to LA remodeling or whether LA remodeling or AF induces elevation in CRP and inflammation.

Hypertension and paroxysmal atrial fibrillation: a novel predictive role of high sensitivity C-reactive protein in cardioversion and long-term recurrence

“…[34][35][36] It has been recently shown that atrial structural remodelling, assessed by left atrial diameter, correlated positively with hsCRP levels in patients with PAF. 23,37,38 Such a relation, however, was not supported by our results. A possible explanation could be the difference in the way we assessed left atrial size, by measuring left atrial volume instead of atrial diameter.…”

EHRA/HRS/APHRS/SOLAECE expert consensus on atrial cardiomyopathies: definition, characterization, and clinical implication

“…267,[483][484][485] Recently, giant-cell myocarditis involving only the atria has been shown to result in atrial fibrillation with enlarged atria. 149 Patients with apparently lone atrial fibrillation frequently demonstrate histological findings consistent with an atrial myocarditis; 486 and those with past myocarditis may have atrial electrical scar, conduction abnormalities, or atrial standstill.…”

Atrial fibrillation and inflammation

“…In a multivariate analysis of The Cardiovascular Health Study that included 5806 individuals, CRP levels predicted both the presence of AF at baseline and the development of AF during followup, even after adjustment for potential confounding factors [7] . Moreover, longer duration of AF has been found to be associated with higher hs-CRP levels compared with shorter duration of AF, which indicates that there is a link between AF burden and systemic inflammation [8,15] . Similarly, hs-CRP has been found to be a significant predictor of early AF recurrence after cardioversion [11,[16][17][18][19][20] .…”