Comparing biomarker profiles of patients with heart failure: atrial fibrillation vs. sinus rhythm and reduced vs. preserved ejection fraction

Bernadet T. Santema, Marielle Kloosterman, Isabelle C. Van Gelder, Ify Mordi, Chim Lang, Carolyn S. P. Lam, Stefan D. Anker, John G. F. Cleland, Kenneth Dickstein, Gerasimos S. Filippatos, Pim van der Harst, Hans L. Hillege, Jozine M. ter Maaten, Marco Metra, Leong Loke Ng, Piotr Ponikowski, Nilesh J. Samani, Dirk Jan van Veldhuisen, Aeilko H. Zwinderman, Faiez ZannadKevin Damman, Peter van der Meer, Michiel Rienstra, Adriaan A. Voors

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Abstract

Aims: The clinical correlates and consequences of atrial fibrillation (AF) might be different between heart failure with reduced vs. preserved ejection fraction (HFrEF vs. HFpEF). Biomarkers may provide insights into underlying pathophysiological mechanisms of AF in these different heart failure (HF) phenotypes. Methods and results: We performed a retrospective analysis of the BIOlogy Study to TAilored Treatment in Chronic Heart Failure (BIOSTAT-CHF), which was an observational cohort. We studied 2152 patients with HFrEF [ejection fraction (EF < 40%)], of which 1419 were in sinus rhythm (SR) and 733 had AF. Another 524 patients with HFpEF (EF ≥50%) were studied, of which 286 in SR and 238 with AF. For the comparison of biomarker profiles, 92 cardiovascular risk markers were measured (Proseek® Olink Cardiovascular III panel). The circulating risk marker pattern observed in HFrEF was different than the pattern in HFpEF: in HFrEF, AF was associated with higher levels of 77 of 92 (84%) risk markers compared to SR; whereas in HFpEF, many more markers were higher in SR than in AF. Over a median follow-up of 21 months, AF was associated with increased mortality risk [multivariable hazard ratio (HR) of 1.27; 95% confidence interval (CI) 1.09-1.48, P = 0.002]; there was no significant interaction between heart rhythm and EF group on outcome. Conclusion: In patients with HFrEF, the presence of AF was associated with a homogeneously elevated cardiovascular risk marker profile. In contrast, in patients with HFpEF, the presence of AF was associated with a more scattered risk marker profile, suggesting differences in underlying pathophysiological mechanisms of AF in these HF phenotypes.

Original languageEnglish
Pages (from-to)3867-3875
Number of pages9
JournalEuropean Heart Journal
Volume39
Issue number43
Early online date22 Aug 2018
DOIs
Publication statusPublished - 14 Nov 2018

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Keywords

  • Atrial fibrillation
  • Heart failure
  • Preserved ejection fraction
  • Biomarkers

Cite this

Santema, B. T., Kloosterman, M., Van Gelder, I. C., Mordi, I., Lang, C., Lam, C. S. P., Anker, S. D., Cleland, J. G. F., Dickstein, K., Filippatos, G. S., van der Harst, P., Hillege, H. L., ter Maaten, J. M., Metra, M., Ng, L. L., Ponikowski, P., Samani, N. J., van Veldhuisen, D. J., Zwinderman, A. H., ... Voors, A. A. (2018). Comparing biomarker profiles of patients with heart failure: atrial fibrillation vs. sinus rhythm and reduced vs. preserved ejection fraction. European Heart Journal, 39(43), 3867-3875. https://doi.org/10.1093/eurheartj/ehy421