Role of Soluble ST2 Biomarker in Predicting Recurrence of Atrial Fibrillation after Electrical Cardioversion or Pulmonary Vein Isolation
Abstract
:1. Introduction
2. Results
2.1. Baseline Characteristics
2.2. Characteristics of Patients with Atrial Fibrillation vs. Those of Control Participants
2.3. Characteristics of Patients According to the Procedure Performed
2.4. Recurrence of AF and ST2S Biomarker
2.5. Recurrence of AF and sST2 Biomarker Patients Undergoing CVE
2.6. Recurrence of AF and sST2 in Patients Undergoing PVI
2.7. Recurrence of AF and sST2 Biomarker in the Global Cohort Excluding Patients Who Underwent a Procedure during Follow-Up
2.8. Predictive Capacity of the sST2 Biomarker for AF Recurrence
2.8.1. ROC Curve of the Baseline Biomarker (sST2.0) in the Cohort of Patients Undergoing ECV and Recurrence at 3 Months
2.8.2. ROC Curve of the Biomarker sST2 at 3-Month Follow-Up (sST2.1) in the Cohort of Patients Undergoing ECV and Recurrence from 3 to 6 Months
2.8.3. ROC Curve of the Biomarker sST2.0 in the Cohort of Patients Undergoing PVI and Recurrence at 3 Months
2.8.4. ROC Curve of the Biomarker ST2S.1 in the Cohort of Patients Undergoing PVI and Recurrence from 3 to 6 Months
2.9. Logistic Regression Models to Predict AF Recurrence
2.9.1. Logistic Regression Models in Patients Undergoing ECV
2.9.2. Logistic Regression Models in Patients Undergoing PVI
2.10. sST2 Biomarker and LA Low-Voltage Areas
3. Discussion
3.1. Baseline sST2 in AF Patients and Controls
3.2. Baseline sST2 and AF Recurrence
3.3. sST2 at 3 Months of Follow-Up and AF Recurrence
3.4. sST2 in PVI Patients and Fibrosis
3.5. Limitations
4. Methods and Materials
4.1. Study Design
4.2. Study Population
4.2.1. Inclusion Criteria
4.2.2. Exclusion Criteria
4.3. sST2 Measurement
4.4. AF Ablation/Electrical Cardioversion
4.5. Follow-Up
4.6. Statistical Analysis
4.7. Ethical Considerations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Abbreviations
sST2 | soluble suppression of tumorigenicity 2 |
AF | atrial fibrillation |
ECV | electrical cardioversion |
PVI | pulmonary vein ablation |
HF | heart failure |
LVEF | left ventricular ejection fraction |
References
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ECV (n = 94) | PVI (n = 156) | P1 | Control (n = 40) | P2 | |
---|---|---|---|---|---|
Age (years) | 61.1 ± 9.1 | 56.9 ± 10.7 | 0.001 * | 55.8 ± 11.3 | 0.068 |
Men (n, %) | 74 (78.7) | 110 (70.5) | 0.154 | 25 (62.5) | 0.146 |
Weight (kg) | 86.5 ± 13.1 | 86.5 ± 14.7 | 0.494 | 74.6 ± 12.1 | <0.000 * |
Height | 1.69 ± 0.09 | 1.69 ± 0.09 | 0.378 | 1.67 ± 0.09 | 0.094 |
BMI (kg/m2) | 30.2 ± 4.3 | 30.3 ± 4.4 | 0.423 | 26.6 ± 2.89 | <0.000 * |
HT (n, %) | 50 (53.2) | 68 (43.6) | 0.141 | 3 (7.5) | <0.000 * |
DM (n, %) | 10 (10.6) | 13 (8.3) | 0.541 | 2 (5) | 0.379 |
Smoking (n, %) | 22 (23.4) | 47 (30.1) | 0.249 | 11 (27.5) | 0.989 |
COPD (n, %) | 6 (6.4) | 8 (5.1) | 0.676 | 2 (5) | 0.877 |
OSA (n, %) | 5 (5.3) | 9 (5.8) | 0.881 | 0 | 0.230 |
CKD (n, %) | 1 (1.1) | 5 (3.2) | 0.284 | 0 | 1 |
Obesity (n, %) | 36 (38.3) | 76 (48.7) | 0.108 | 7 (17.5) | 0.001 * |
Tachycardiomyopathy (n, %) | 12 (12.8) | 19 (12.2) | 0.892 | 0 | 0.011 * |
Time from first AF diagnosis (months) | 24.1 (32.2) | 58.2 (70.1) | <0.000 * | ||
AF pattern (n, %) -Paroxysmal (n = 68) -Persistent (n = 182) | |||||
0 (0) | 68 (100) | <0.000 | |||
94 (51.6) | 88 (48.4) | 0.234 | |||
RA Area (cm2) | 15.4 ± 4.2 | 13.6 ± 3.9 | 0.000 * | 12.8 ± 3.1 | 0.001 * |
LA AP Diameter (mm) | 45.2 ± 5.5 | 41.2 ± 6.2 | 0.078383 | 23 ± 3.9 | <0.000 * |
LA Area (cm2) | 24.2 ± 5 | 21.5 ± 5.4 | 0.090 | 13 ± 3.2 | <0.000 * |
LA Volume (mL) | 96.2 ± 47.5 | 94.4 ± 54.3 | 0.397 | 53 ± 30.9 | <0.000 * |
LA Index Volume (mL/m2) | 48.3 ± 22.5 | 47.9 ± 27.8 | 0.446 | 28.7 ± 16.8 | <0.000 * |
LVEF (%) | 61.4 ± 7.2 | 62.6 ± 7.2 | 0.103 | 63 ± 6 | 0.176 |
LVEDV (mL) | 60.4 ± 23.2 | 56.4 ± 25.6 | 0.106 | 59 ± 21.8 | 0.382 |
LVESV (mL) | 23.2 ± 10.4 | 21.3 ± 10.8 | 0.092 | 22 ± 8.5 | 0.408 |
LVEDd (mm) | 39.3 ± 7.1 | 38.9 ± 8.7 | 0.374 | 38 ± 7.1 | 0.349 |
LVESd (mm) | 27.2 ± 4.3 | 26.9 ± 6.1 | 0.338 | 27 ± 4.8 | 0.415 |
RVEDd (mm) | 26.7 ± 4.8 | 26.7 ± 4.7 | 0.496 | 25 ± 4.5 | 0.027 * |
Glucose (mg/dL) | 105.1 ± 23.3 | 98.3 ± 18 | 0.041 * | ||
Urea (mg/dL) | 45.6 ± 14.5 | 39.2 ± 10.8 | 0.005 * | ||
Creatinine (mg/dL) | 0.98 ± 0.30 | 0.80 ± 0.16 | 0.001 * | ||
Hb1Ac (%) | 6.9 ± 1.2 | 5.3 ± 0.7 | 0.001 * | ||
TSH (mU/L) | 2.9 ± 2.4 | 3.1 ± 5.7 | 0.232 | ||
AAD (n, %) -Amiodarone -Flecainide -Propafenone -Betablockers -Calcium antagonists | 92 (97.8) | 152 (97.4) | 0.542 | 11(27.5) | 0.001 * |
44 (46.8) | 48 (30.8) | ||||
46 (48.9) | 101 (64.7) | ||||
2 (2.1) | 3 (1.9) | ||||
88 (93.6) | 138 (88.5) | ||||
2 (2.1) | 8 (5.1) | ||||
sST2.0 (pg/mL) | 17,163 ± 9147 | 13,178 ± 7223 | 0.000 * | 11,016 ± 5618 | 0.007 * |
sST2.0 and AF type (pg/mL) -Paroxysmal -Persistent -Persistent vs. paroxysmal | |||||
12,113 ± 6278 | 11,016 ± 5618 | 0.234 | |||
15,634 ± 8651 | 11,016 ± 5618 | 0.011 * | |||
15,634 ± 8651 vs. 12,113 ± 6278 | 0.002 * | ||||
sST2.0 and initial rhythm (pg/mL) -Sinus rhythm, n = 89 -AF, n = 161 | 0.003 * | ||||
12,626 ± 6483 | |||||
15,810 ± 8846 | |||||
sST2.0 and rate (pg/mL) <100 bpm, n = 221 ≥100 bpm, n = 29 | 0.065 | ||||
14,330 ± 7641 | |||||
17,321 ± 11,534 | |||||
sST2.0 and rate in persistent AF (pg/mL) <100 bpm, n = 159 ≥100 bpm, n = 23 | 0.032 * | ||||
15,113 ± 7941 | |||||
19,237 ± 12,136 |
Recurrence from 0 to 3 Months FU | Recurrence from 3 to 6 Months FU | Recurrence from 0 to 6 Months FU | |||||
---|---|---|---|---|---|---|---|
NO n = 172 | Yes n = 78 | NO n = 186 | Yes n = 64 | NO n = 146 | Yes n = 104 | ||
Paroxysmal | ECV | - | - | - | - | - | - |
PVI | 60 | 8 | 60 | 8 | 54 | 14 | |
Persistent | ECV | 47 | 47 | 53 | 41 | 36 | 58 |
PVI | 65 | 23 | 73 | 15 | 56 | 32 |
sST2.0 | sST2.1 | p | ||
3-month FU | No recurrence FU(n = 47) | 18,598 ± 10,916 | 14,680 ± 7561 | 0.002 * |
Recurrence (n = 47) | 15,729 ± 6768 | 16,133 ± 7218 | 0.618 | |
sST2.0 | sST2.2 | p | ||
6-month FU | No recurrence (n = 53) | 16,313 ± 10,114 | 13,931 ± 7211 | 0.019 * |
Recurrence FU2 (n = 41) | 18,263 ± 7611 | 18,950 ± 9402 | 0.559 | |
sST2.1 | sST2.2 | p | ||
3- vs. 6-month FU | No recurrence (n = 53) | 13,350 ± 5941 | 13,931 ± 7211 | 0.286 |
Recurrence (n = 41) | 18,066 ± 8256 | 18,950 ± 9402 | 0.277 |
sST2.0 | sST2.1 | p | ||
3-month FU | No recurrence (n = 125) | 13,033 ± 7408 | 14,109 ± 8108 | 0.05 |
Recurrence (n = 31) | 13,765 ± 6501 | 14,263 ± 6430 | 0.565 | |
sST2.0 | sST2.2 | p | ||
6-month FU | No recurrence (n = 133) | 13,302 ± 7431 | 14,302 ± 6945 | 0.022 * |
Recurrence (n = 23) | 12,461 ± 5837 | 13,571 ± 4181 | 0.451 | |
sST2.1 | sST2.2 | p | ||
3- vs. 6-month FU | No recurrence (n = 133) | 14,301 ± 8130 | 14,302 ± 6945 | 0.997 |
Recurrence (n = 23) | 13,208 ± 5405 | 13,571 ± 4181 | 0.728 |
(A) | ||||
OR | CI 95% | p | ||
Age (years) | 0.980 | 0.927 | 1.035 | 0.223 |
Gender—male | 0.443 | 0.123 | 1.503 | 0.165 |
LA index volume (mL/m2) | 1.028 | 1.007 | 1.051 | 0.006 * |
BMI (kg/m2) | 1.008 | 0.911 | 1.121 | 0.674 |
Rate (bpm) | 1.006 | 0.981 | 1.030 | 0.145 |
sST2.0 (pg/mL) | 0.999 | 0.999 | 1.000 | 0.357 |
(B) | ||||
OR | CI 95% | p | ||
Age (years) | 1.054 | 0.991 | 1.127 | 0.203 |
Gender—male | 2.168 | 0.863 | 3.530 | 0.751 |
LA index volume (mL/m2) | 0.986 | 1.009 | 1.034 | 0.122 |
BMI (kg/m2) | 0.940 | 1.009 | 1.034 | 0.417 |
Rate (bpm) | 0.997 | 0.963 | 1.033 | 0.809 |
Rhythm at 3 months: AF | 7.403 | 2.188 | 28.192 | 0.001 * |
sST2.1 (pg/mL) | 1.345 | 1.085 | 1.823 | 0.001 * |
(A) | ||||
OR | CI 95% | p | ||
Age (years) | 0.974 | 0.924 | 1.026 | 0.330 |
Gender—male | 0.261 | 0.065 | 0.974 | 0.049 * |
BMI (kg/m2) | 0.916 | 0.802 | 1.033 | 0.281 |
Rate (bpm) | 0.956 | 0.918 | 0.989 | 0.019 * |
Rhythm at basal: AF | 5.702 | 1.289 | 6.497 | 0.023 * |
Type AF (persistent) | 2.122 | 0.505 | 9.248 | 0.302 |
sST2.0 | 1.000 | 0.999 | 1.000 | 0.353 |
LA index volume (mL/m2) | 1.027 | 1.009 | 1.047 | 0.047 * |
Low-voltage area (%) | 1.008 | 0.986 | 1.032 | 0.376 |
(B) | ||||
OR | CI 95% | p | ||
Age (years) | 1.017 | 0.962 | 1.081 | 0.582 |
Gender—male | 1.166 | 0.305 | 4.868 | 0.799 |
BMI (kg/m2) | 1.036 | 0.898 | 1.188 | 0.625 |
Rate (bpm) | 0.969 | 0.915 | 1.023 | 0.171 |
Rhythm at 3 months: AF | 3.001 | 2.919 | 4.262 | 0.004 * |
Type of AF (persistent) | 2.247 | 0.164 | 6.290 | 0.625 |
sST2.1 (pg/mL) | 0.999 | 0.999 | 0.9999 | 0.390 |
LA index volume (mL/m2) | 0.999 | 0.999 | 1.000 | 0.209 |
Low-voltage area (%) | 1.018 | 0.989 | 1.047 | 0.288 |
Low-Voltage Area (%) | ST2S.0 (pg/mL) |
---|---|
<5 (n = 49) | 11,324 ± 5698 |
5 to 35 (n = 62) | 14,294 ± 7621 |
>35 (n = 17) | 10,983 ± 6679 |
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García-Seara, J.; González Melchor, L.; Rodríguez García, J.; Gude, F.; Martínez Sande, J.L.; Rodríguez Mañero, M.; Fernández López, X.A.; Minguito Carazo, C.; González Ferrero, T.; Eiras, S.; et al. Role of Soluble ST2 Biomarker in Predicting Recurrence of Atrial Fibrillation after Electrical Cardioversion or Pulmonary Vein Isolation. Int. J. Mol. Sci. 2023, 24, 14045. https://doi.org/10.3390/ijms241814045
García-Seara J, González Melchor L, Rodríguez García J, Gude F, Martínez Sande JL, Rodríguez Mañero M, Fernández López XA, Minguito Carazo C, González Ferrero T, Eiras S, et al. Role of Soluble ST2 Biomarker in Predicting Recurrence of Atrial Fibrillation after Electrical Cardioversion or Pulmonary Vein Isolation. International Journal of Molecular Sciences. 2023; 24(18):14045. https://doi.org/10.3390/ijms241814045
Chicago/Turabian StyleGarcía-Seara, Javier, Laila González Melchor, Javier Rodríguez García, Francisco Gude, José Luis Martínez Sande, Moisés Rodríguez Mañero, Xesús Alberte Fernández López, Carlos Minguito Carazo, Teba González Ferrero, Sonia Eiras, and et al. 2023. "Role of Soluble ST2 Biomarker in Predicting Recurrence of Atrial Fibrillation after Electrical Cardioversion or Pulmonary Vein Isolation" International Journal of Molecular Sciences 24, no. 18: 14045. https://doi.org/10.3390/ijms241814045