Abstract 2120: Circulating Markers of Myocyte Injury Predict First Recurrence of Atrial Fibrillation. Data from the GISSI-Atrial Fibrillation Trial

Whether circulating biomarkers may help in predicting long-term maintenance of sinus rhythm in patients with atrial fibrillation (AF) is still debated. We evaluated the prognostic role of two markers of cardiomyocyte injury in patients with a history of recent AF. Baseline plasma concentrations of NT-proBNP and cardiac troponin T (high sensitive, for evaluation purposes only) were measured (Elecsys 2010, Roche Diagnostics) in 382 patients diagnosed with symptomatic AF having additional underlying cardiovascular diseases/comorbidities, enrolled in 36 centers participating to GISSI-AF, a prospective randomized study. The association between these markers, clinical characteristics and outcome (adjudicated primary endpoint: time to first recurrence of AF) was tested by univariate and multivariable Cox models. Baseline concentrations of NT-proBNP and hsTnT were 191 [95–363] pg/mL (median [Q1–Q3]) and 0.008 [0.006 – 0.013] ng/mL in these patients with a history of AF (62.8% males, 46.1% aged > 70 y, 11% with either HF or depressed LVEF, 13.1% diabetics, 33.3% with SBP >140 mmHg ). Both markers were elevated in older patients (>70 y), those with HF and/or LVEF<0.40 or with creatinine >1 mg/dL. Above median concentrations of hsTnT (HR [95%CI] adjusted for gender 1.35 [1.02–1.78], p=0.038) and NT-proBNP (1.34 [1.01–1.78], p=0.040) were associated with higher risk of experiencing a first recurrence of AF (203 patients, 53.1%). Even small elevations of circulating markers of cardiomyocyte death (troponin) and stretch (natriuretic peptide) may be useful for the prediction of recurrence of AF in patients with a history of recent AF.