Cardiovascular magnetic resonance-determined left ventricular myocardium impairment is associated with C-reactive protein and ST2 in patients with paroxysmal atrial fibrillation

Abstract

Background Myocardial strain assessed with cardiovascular magnetic resonance (CMR) feature tracking can detect early left ventricular (LV) myocardial deformation quantitatively in patients with a variety of cardiovascular diseases, but this method has not yet been applied to quantify myocardial strain in patients with atrial fibrillation (AF) and no coexistent cardiovascular disease, i.e., the early stage of AF. This study sought to compare LV myocardial strain and T1 mapping indices in AF patients and healthy subjects, and to investigate the associations of a portfolio of inflammation, cardiac remodeling and fibrosis biomarkers with LV myocardial strain and T1 mapping indices in AF patients with no coexistent cardiovascular disease. Methods The study consisted of 80 patients with paroxysmal AF patients and no coexistent cardiovascular disease and 20 age- and sex-matched healthy controls. Left atrial volume (LAV), LV myocardial strain and native T1 were assessed with CMR, and compared between the AF patients and healthy subjects. Biomarkers of C-reactive protein (CRP), transforming growth factor beta-1 (TGF-β1), collagen III N-terminal propeptide (PIIINP), and soluble suppression of tumorigenicity 2 (sST2) were obtained with blood tests, and compared between the AF patients and healthy controls. Associations of these biomarkers with those CMR-measured parameters were analyzed for the AF patients. Results For the CMR-measured parameters, the AF patients showed significantly larger LAV and LV end-systolic volume, and higher native T1 than the healthy controls (max P = 0.027). The absolute values of the LV peak systolic circumferential strain and its rate as well as the LV diastolic circumferential strain rate were all significantly reduced in the AF patients (all P < 0.001). For the biomarkers, the AF patients showed significantly larger CRP (an inflammation biomarker) and sST2 (a myocardium stiffness biomarker) than the controls (max P = 0.007). In the AF patients, the five CMR-measured parameters of LAV, three LV strain indices and native T1 were all significantly associated with these two biomarkers of CRP and sST2 (max P = 0.020). Conclusions In patients with paroxysmal AF and no coexistent cardiovascular disease, LAV enlargement and LV myocardium abnormalities were detected by CMR, and these abnormalities were associated with biomarkers that reflect inflammation and myocardial stiffness.

Vericiguat reduces electrical and structural remodeling in a rabbit model of atrial fibrillation

“…39 Levels of ST2 are known to increase significantly in both heart failure and AF. 40,41 Here, marked enlargement of the atria of rabbits in the RAP group was seen on echocardiography, a clear indication of structural remodeling, and the LVEF was also reduced, although it did not reach the degree of HFrEF and worsening of HF. CVF levels also increased significantly in the RAP group, shown by, and western blotting and biochemical assays demonstrated raised levels of collagens I and III and ST2 in the RAP group, an indication that atrial fibrosis was a consequence of rapid pacing.…”

Biomarkers for Predicting the Occurrence and Progression of Atrial Fibrillation: Soluble Suppression of Tumorigenicity 2 Protein and Tissue Inhibitor of Matrix Metalloproteinase-1

“…Moreover, the most prominent risk factors for AF development, such as age, sex, increased BMI, hypertension, and HF, have all been related to elevated natriuretic peptide concentrations. Previous studies showed that patients with AF had signifcantly higher CRP levels than the SR group [20], and elevated hs-CRP levels were signifcantly associated with an increased risk of AF [35][36][37]. However, circulating BNP and CRP are known biomarkers for systemic circulation and can be infuenced by many factors, such as HF and acute or chronic infammation.…”

“…In the current study, the results also showed a higher serum level of sST2 in patients with persistent AF. In another study, patients with AF showed significantly higher sST2 than the control group did [ 20 ]. This study consistently found that sST2 was higher in patients with SR and increased gradually as a patient moved from SR to paroxysmal persistent AF.…”

Clinical and Laboratory Biomarkers in Paroxysmal Atrial Fibrillation: A Single Center Cross‐Sectional Study

“…Okar and colleagues reported that soluble ST2, as measured prior to an ablation procedure, is an independent parameter for predicting AF recurrence [ 11 ]. Other studies have suggested that sST2 was associated with LA volume enlargement, the LA low-voltage zone, and LV myocardium abnormalities in patients with paroxysmal AF [ 12 , 13 ]. Similar to the above findings, our results indicate that the median sST2 concentration of the pAF group was 12.76 ± 4.73 ng/ml, higher than that of the SR group.…”