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Wakula, P; Neumann, B; Kienemund, J; Thon-Gutschi, E; Stojakovic, T; Manninger, M; Scherr, D; Scharnagl, H; Kapl, M; Pieske, B; Heinzel, FR.
CHA2DS2-VASc score and blood biomarkers to identify patients with atrial high-rate episodes and paroxysmal atrial fibrillation.
Europace. 2017; 19(4):544-551 Doi: 10.1093/europace/euw101 [OPEN ACCESS]
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Führende Autor*innen der Med Uni Graz
Heinzel Frank
Wakula-Heinzel Paulina
Co-Autor*innen der Med Uni Graz
Kapl Martin
Manninger-Wünscher Martin
Pieske Burkert Mathias
Scharnagl Hubert
Scherr Daniel
Stojakovic Tatjana
Thon-Gutschi Eva-Maria

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Paroxysmal atrial fibrillation (PAF) is often asymptomatic but nonetheless harmful. We evaluated the performance of disease-related blood biomarkers and CHA2DS2-VASc score to discriminate for PAF in patients with continuous rhythm monitoring. Clinical data and blood samples were obtained from patients with dual-chamber pacemakers selected according to the absence (no_AHRE) or presence of Atrial High-Rate Episodes (AHRE) >6 min in recent device history (case-control approach). We included 93 patients (n = 49 AHRE, n = 44 no_AHRE). In a subgroup with high AHRE burden and confirmed PAF 15 biomarkers were evaluated (n = 19 AHRE-AF vs. n = 20 no_AHRE). Significantly regulated biomarkers were then tested in all patients to distinguish no_AHRE from AHRE (receiver operating characteristics analysis). Hsp27, TGFβ1, cystatin C, matrix metalloproteinases MMP-2,-3,-9, albumin, and serum uric acid were not altered in the subgroup. Tissue inhibitors of metalloproteinases (TIMP) -1,-2,-4; NT-proANP, NT-proBNP, IL-6 and serum amyloid protein A were significantly different in AHRE vs. no_AHRE (subgroup and whole cohort), with best discriminatory performance for TIMP-4. Biomarkers performed better than CHADS2-VASc for AHRE discrimination. Intracardial electrograms and medical history from seven AHRE patients suggested atrial tachycardia and not AF (AHRE-AT). Four of the most relevant regulated biomarkers (TIMP-4, TIMP-2, SAA, NT-proBNP) behaved similarly in AHRE-AT and AHRE-AF. NT-proBNP >150 pg/mL indicated an odds ratio of 12.9 for AHRE. Combining two biomarkers significantly improved discrimination of AHRE. TIMP-4, NT-proANP, NT-proBNP were strongest associated with PAF and AHRE. The discriminatory performance of CHADS2-VASc for PAF was increased by addition of selected biomarkers. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2016. For permissions please email:
Find related publications in this database (using NLM MeSH Indexing)
Aged -
Aged, 80 and over -
Atrial Fibrillation - blood
Atrial Fibrillation - diagnosis
Atrial Fibrillation - epidemiology
Atrial Natriuretic Factor - blood
Biomarkers - blood
Causality -
Comorbidity -
Electrocardiography - statistics & numerical data
Female -
Germany - epidemiology
Humans -
Incidence -
Interleukin-6 - blood
Male -
Natriuretic Peptide, Brain - blood
Peptide Fragments - blood
Reproducibility of Results -
Risk Assessment - methods
Sensitivity and Specificity -
Serum Amyloid A Protein - analysis
Stroke - blood
Stroke - diagnosis
Stroke - epidemiology
Tissue Inhibitor of Metalloproteinases - blood

Find related publications in this database (Keywords)
Paroxysmal atrial fibrillation
Atrial high rate episodes
CHA(2)DS(2)-VASc score
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