Biomarkers to predict improvement of left ventricular ejection fraction after atrial fibrillation ablation

医学 心脏病学 内科学 心房颤动 射血分数 导管消融 试验预测值 曲线下面积 心力衰竭
作者
Teodor Serban,Elisa Hennings,Ivo Strebel,Sven Knecht,Jeanne du Fay de Lavallaz,Philipp Krisai,Rebecca Arnet,Gian Völlmin,Stefan Osswald,Christian Sticherling,Michael Kühne,Patrick Badertscher
出处
期刊:Heart Rhythm [Elsevier BV]
卷期号:21 (9): 1581-1588
标识
DOI:10.1016/j.hrthm.2024.04.044
摘要

IntroductionAtrial fibrillation (AF) and heart failure (HF) frequently coexist. Prediction of left ventricular ejection fraction (LVEF) recovery after catheter ablation (CA) for AF remains difficult.ObjectivesTo evaluate the value of biomarkers, alone and in conjunction with the Antwerp score to predict LVEF recovery after CA for AF.MethodsPatients undergoing CA for AF with depressed LVEF(<50%) were included. Plasma levels of 13 biomarkers were measured immediately prior to CA. Patients were categorized into "responders" and "non-responders" in similar fashion to the Antwerp score derivation and validation cohorts. The predictive power of the biomarkers alone and combined in outcome prediction was evaluated.Results208 patients with depressed LVEF were included (median age 63 years, 19% female, median LAVI 42 ml/m2, median LVEF 43%). At a median follow-up time of 30 months, 161 (77%) were responders and 47 (23%) were non-responders. Of 13 biomarkers, four (ANG2, GDF15, FGF23 and MyBPC3) were significantly different between responders and non-responders (p ≤0.001) and combined could predict the endpoint with an AUC of 0.72 (95%CI 0.64-0.81) overall, 0.69 (95%CI 0.59-0.78) in HFmrEF and 0.88 (95%CI 0.77-0.98) in HFrEF. Only ANG2 and GDF15 remained significantly associated with LVEF recovery after adjustment for age, sex and Antwerp score and significantly improved the accuracy of the Antwerp score predictions (p<0.001). The AUC of the Antwerp score in the outcome prediction improved from 0.75 (95% CI 0.67-0.83) to 0.78 (95% CI 0.70-0.86)ConclusionA biomarker panel (ANG2, GDF15) significantly improved the accuracy of the Antwerp Score.
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