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Inflammatory activation in an unselected population of subjects with atrial fibrillation: links with structural heart disease, atrial remodeling and recent onset

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Abstract

Previous studies investigated circulating levels of C-reactive protein (CRP) mostly in subjects with paroxysmal atrial fibrillation (AF) and lone AF (LAF). We, therefore, aimed to investigate circulating levels of CRP in patients with new onset AF with particular regards to AF duration, even in the presence of structural heart disease (SHD). CRP levels were evaluated in 96 consecutive patients with new onset AF (50 with LAF and 46 with SHD, 41 with paroxysmal AF (PAF) (<7 days) and 55 persistent AF (>7 days). Patients with AF had higher CRP levels than controls (4.8 ± 6.99 vs. 1.59 ± 1.32 mg/L; p < 0.001). AF patients with SHD had higher CRP levels than LAF patients (7.08 ± 9.19 vs. 2.63 ± 2.47 mg/L; p < 0.01) and control subjects (vs. 1.59 ± 1.32 mg/L; p < 0.001): CRP levels in LAF patients were higher than in controls (p < 0.01). CRP levels were significantly increased in subjects with paroxysmal AF (6.67 ± 9.44 mg/L) with respect to those with persistent AF (3.54 ± 4.44 mg/L, p < 0.05) and controls (1.59 ± 1.32 mg/L, p < 0.001 vs. paroxysmal AF, p < 0.01 vs. persistent AF). Differences related to the presence of LAF and SHD remained significant even after multivariable regression analysis. CRP concentrations significantly correlated with left atrial size(r 0.23, p < 0.05). Increased CRP levels are detectable in patients with AF, proportional to atrial remodeling, recent onset of dysrhythmia and SHD.

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References

  1. Kannel WB, Abbott RD, Savage DD, McNamara PM (1982) Epidemiological features of chronic atrial fibrillation: the Framingham study. N Engl J Med 306:1018–1022

    Article  PubMed  CAS  Google Scholar 

  2. Chung MK, Martin DO, Sprecher D, Wazni O, Kanderian A, Carnes CA, Bauer JA, Tchou PJ, Niebauer MJ, Natale A, Van Wagoner DR (2001) C-reactive protein elevation in patients with atrial arrhythmias: inflammatory mechanisms and persistence of atrial fibrillation. Circulation 104:2886–2891

    Article  PubMed  CAS  Google Scholar 

  3. Dernellis J, Panaretou M (2001) C-reactive protein and paroxysmal atrial fibrillation: evidence of the implication of an inflammatory process in paroxysmal atrial fibrillation. ActaCardiol 56:375–380

    CAS  Google Scholar 

  4. Bruins P, teVelthuis H, Yazdanbakhsh AP, Jansen PJ, van Hardevelt FW, de Beaumont EM, Wildevuur CR, Eijsman L, Trouwborst A, Hack CE (1997) Activation of the complement system during and after cardiopulmonary bypass surgery: postsurgery activation involves C-reactive protein and is associated with postoperative arrhythmia. Circulation 96:3542–3548

    Article  PubMed  CAS  Google Scholar 

  5. Frustaci A, Chimenti C, Bellocci F, Morgante E, Russo MA, Maseri A (1997) Histological substrate of atrial biopsies in patients with lone atrial fibrillation. Circulation 96:1180–1184

    Article  PubMed  CAS  Google Scholar 

  6. Harris TB, Ferrucci L, Tracy RP, Corti MC, Wacholder S, Ettinger WH Jr, Heimowitz H, Cohen HJ, Wallace R (1999) Associations of elevated interleukin-6 and C-reactive protein levels with mortality in the elderly. Am J Med 106:506–512

    Article  PubMed  CAS  Google Scholar 

  7. Ridker PM, Rifai N, Stampfer MJ, Hennekens CH (2000) Plasma concentration of interleukin-6 and the risk of future myocardial infarction among apparently healthy men. Circulation 101:1767–1772

    Article  PubMed  CAS  Google Scholar 

  8. Ridker PM (1999) Inflammation, atherosclerosis, and cardiovascular risk: an epidemiologic view. Blood Coagul Fibrinol 10(Suppl 1):S9–S12

    Google Scholar 

  9. Ridker PM, Buring JE, Shih J, Matias M, Hennekens CH (1998) Prospective study of C-reactive protein and the risk of future cardiovascular events among apparently healthy women. Circulation 98:731–733

    Article  PubMed  CAS  Google Scholar 

  10. ACC/AHA/ESC guidelines for the management of patients with atrial fibrillation (2006) Europace 8:651–745

    Google Scholar 

  11. Aviles RJ, Martin DO, Apperson-Hansen C, Houghtaling PL, Rautaharju P, Kronmal RA, Tracy RP, Van Wagoner DR, Psaty BM, Lauer MS, Chung MK (2003) Inflammation as a risk factor for atrial fibrillation. Circulation 108:3006–3010

    Article  PubMed  Google Scholar 

  12. Bruins P, teVelthuis H, Yazdanbakhsh AP, Jansen PG, van Hardevelt FW, de Beaumont EM, Wildevuur CR, Eijsman L, Trouwborst A, Hack CE (1997) Activation of the complement system during and after cardiopulmonary bypass surgery: postsurgery activation involves C-reactive protein and is associated with postoperative arrhythmia. Circulation 96:3542–3548

    Article  PubMed  CAS  Google Scholar 

  13. del Balzo U, Polley MJ, Levi R (1989) Cardiac anaphylaxis. Complement activation as an amplification system. Circ Res 65:847–857

    Article  PubMed  CAS  Google Scholar 

  14. Volanakis JE, Wirtz KW (1979) Interaction of C-reactive protein with artificial phosphatidylcholine bilayers. Nature 281:155–157

    Article  PubMed  CAS  Google Scholar 

  15. del Balzo UH, Levi R, Polley MJ (1985) Cardiac dysfunction caused by purified human C3a anaphylatoxin. Proc Natl Acad Sci USA 82:886–890

    Article  PubMed  CAS  Google Scholar 

  16. Nattel S (2002) New ideas about atrial fibrillation 50 years on. Nature 415:219–226

    Article  PubMed  CAS  Google Scholar 

  17. Mihm MJ, Yu F, Carnes CA, Reiser PJ, McCarthy PM, Van Wagoner DR, Bauer JA (2001) Impaired myofibrillar energetics and oxidative injury during human atrial fibrillation. Circulation 104:174–180

    Article  PubMed  CAS  Google Scholar 

  18. Acevedo M, Corbalán R, Braun S, Pereira J, Navarrete C, Gonzalez I (2006) C-reactive protein and atrial fibrillation: “evidence for the presence of inflammation in the perpetuation of the arrhythmia”. Int J Cardiol 108(3):326–331

    Article  PubMed  Google Scholar 

  19. Yao SY, Chu JM, Chen KP, Tang M, Fang PH, Wang FZ, Zhang S (2009) Inflammation in lone atrial fibrillation. Clin Cardiol 32:94–98

    Article  PubMed  Google Scholar 

  20. Marcus GM, Smith LM, Ordovas K, Scheinman MM, Kim AM, Badhwar N, Lee RJ, Tseng ZH, Lee BK, Olgin JE (2010) Intracardiac and extracardiac markers of inflammation during atrial fibrillation. Heart Rhythm 7:149–154

    Article  PubMed  Google Scholar 

  21. Marott SC, Nordestgaard BG, Zacho J, Friberg J, Jensen GB, Tybjaerg-Hansen A, Benn M (2010) Does elevated C-reactive protein increase atrial fibrillation risk? A Mendelian randomization of 47,000 individuals from the general population. J Am Coll Cardiol 56:789–795

    Article  PubMed  Google Scholar 

  22. Watanabe E, Arakawa T, Uchiyama T, Kodama I, Hishida H (2006) High-sensitivity C-reactive protein is predictive of successful cardioversion for atrial fibrillation and maintenance of sinus rhythm after cardioversion. Int J Cardiol 108:346–353

    Article  PubMed  Google Scholar 

  23. Psychari SN, Apostolou TS, Sinos L, Hamodraka E, Liakos G, Kremastinos DT (2005) Relation of elevated C-reactive protein and interleukin-6 levels to left atrial size and duration of episodes in patients with atrial fibrillation. Am J Cardiol 95:764–767

    Article  PubMed  CAS  Google Scholar 

  24. Watanabe T, Takeishi Y, Hirono O, Itoh M, Matsui M, Nakamura K, Tamada Y, Kubota I (2005) C-reactive protein elevation predicts the occurrence of atrial structural remodeling in patients with paroxysmal atrial fibrillation. Heart Vessels 20:45–49

    Article  PubMed  Google Scholar 

  25. Dernellis J, Panaretou M (2006) Left atrial function in patients with high C-reactive protein level and paroxysmal atrial fibrillation. Acta Cardiol 61:507–511

    Article  PubMed  Google Scholar 

  26. Casaclang-Verzosa G, Barnes ME, Blume G, Seward JB, Gersh BJ, Cha SS, Bailey KR, Tsang TS (2010) C-reactive protein, left atrial volume, and atrial fibrillation: a prospective study in high-risk elderly. Echocardiography 27:394–399

    Article  PubMed  Google Scholar 

  27. Nakamura Y, Nakamura K, Fukushima-Kusano K, Ohta K, Matsubara H, Hamuro T, Yutani C, Ohe T (2003) Tissue factor expression in atrial endothelia associated with nonvalvular atrial fibrillation: possible involvement in intracardiac thrombogenesis. Thromb Res 111:137–142

    Article  PubMed  CAS  Google Scholar 

  28. Brunetti ND, Maulucci G, Casavecchia GP, Distaso C, De Gennaro L, Pellegrino PL, Di Biase M (2007) Improvement in endothelium dysfunction in diabetics treated with statins: a randomized comparison atorvastatin 20 mg vs. rosuvastatin 10 mg. J Interv Cardiol 20:481–487

    Article  PubMed  Google Scholar 

  29. Dernellis J, Panaretou M (2005) Effect of C-reactive protein reduction on paroxysmal atrial fibrillation. Am Heart J 150:1064

    Article  PubMed  Google Scholar 

  30. Fauchier L, Pierre B, de Labriolle A, Grimard C, Zannad N, Babuty D (2008) Antiarrhythmic effect of statin therapy and atrial fibrillation: a meta-analysis of randomized controlled trials. J Am Coll Cardiol 51:828–835

    Article  PubMed  CAS  Google Scholar 

  31. Kawamura M, Ito H, Onuki T, Miyoshi F, Watanabe N, Asano T, Tanno K, Kobayashi Y (2010) Candesartan decreases type III procollagen-N-peptide levels and inflammatory marker levels and maintains sinus rhythm in patients with atrial fibrillation. J Cardiovasc Pharmacol 55:511–517

    PubMed  CAS  Google Scholar 

  32. Schneider MP, Hua TA, Böhm M, Wachtell K, Kjeldsen SE, Schmieder RE (2010) Prevention of atrial fibrillation by Renin–Angiotensin system inhibition a meta-analysis. J Am Coll Cardiol 55:2299–2230

    Google Scholar 

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Authors and Affiliations

  1. Cardiology Department, University of Foggia, Foggia, Italy

    Pier Luigi Pellegrino, Natale Daniele Brunetti, Luisa De Gennaro, Luigi Ziccardi, Massimo Grimaldi & Matteo Di Biase

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  1. Pier Luigi Pellegrino
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  2. Natale Daniele Brunetti
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  3. Luisa De Gennaro
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  4. Luigi Ziccardi
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Correspondence to Natale Daniele Brunetti.

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Pellegrino, P.L., Brunetti, N.D., De Gennaro, L. et al. Inflammatory activation in an unselected population of subjects with atrial fibrillation: links with structural heart disease, atrial remodeling and recent onset. Intern Emerg Med 8, 123–128 (2013). https://doi.org/10.1007/s11739-011-0557-z

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  • DOI: https://doi.org/10.1007/s11739-011-0557-z

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