Fabritz, L;
Chua, W;
Cardoso, VR;
Al-Taie, C;
Borof, K;
Suling, A;
Krause, L;
Kany, S;
Magnussen, C;
Wegscheider, K;
et al.
Fabritz, L; Chua, W; Cardoso, VR; Al-Taie, C; Borof, K; Suling, A; Krause, L; Kany, S; Magnussen, C; Wegscheider, K; Breithardt, G; Crijns, HJGM; Camm, AJ; Gkoutos, G; Ellinor, PT; Goette, A; Schotten, U; Wienhues-Thelen, U-H; Zeller, T; Schnabel, RB; Zapf, A; Kirchhof, P
(2024)
Blood-based cardiometabolic phenotypes in atrial fibrillation and their associated risk: EAST-AFNET 4 biomolecule study.
Cardiovasc Res, 120 (8).
pp. 855-868.
ISSN 1755-3245
https://doi.org/10.1093/cvr/cvae067
SGUL Authors: Camm, Alan John
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Abstract
AIMS: Atrial fibrillation (AF) and concomitant cardiometabolic disease processes interact and combine to lead to adverse events, such as stroke, heart failure, myocardial infarction, and cardiovascular death. Circulating biomolecules provide quantifiable proxies for cardiometabolic disease processes. The aim of this study was to test whether biomolecule combinations can define phenotypes in patients with AF. METHODS AND RESULTS: This pre-specified analysis of the EAST-AFNET 4 biomolecule study assigned patients to clusters using polytomous variable latent-class analysis based on baseline concentrations of 13 precisely quantified biomolecules potentially reflecting ageing, cardiac fibrosis, metabolic dysfunction, oxidative stress, cardiac load, endothelial dysfunction, and inflammation. In each cluster, rates of cardiovascular death, stroke, or hospitalization for heart failure or acute coronary syndrome, the primary outcome of EAST-AFNET 4, were calculated and compared between clusters over median 5.1 years follow-up. Findings were independently validated in a prospective cohort of 748 patients with AF (BBC-AF; median follow-up 2.9 years).Unsupervised biomolecule analysis assigned 1586 patients (71 years old, 46% women) into four clusters. The highest risk cluster was dominated by elevated bone morphogenetic protein 10, insulin-like growth factor-binding protein 7, N-terminal pro-B-type natriuretic peptide, angiopoietin 2, and growth differentiation factor 15. Patients in the lowest risk cluster showed low concentrations of these biomolecules. Two intermediate-risk clusters differed by high or low concentrations of C-reactive protein, interleukin-6, and D-dimer. Patients in the highest risk cluster had a five-fold higher cardiovascular event rate than patients in the low-risk cluster. Early rhythm control was effective across clusters (Pinteraction = 0.63). Sensitivity analyses and external validation in BBC-AF replicated clusters and risk gradients. CONCLUSION: Biomolecule concentrations identify cardiometabolic subphenotypes in patients with AF at high and low cardiovascular risk.
Item Type: | Article | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Additional Information: | © The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com. | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Keywords: | Atrial fibrillation, Biomolecules, Heart failure, Metabolism, Risk prediction, Stroke, Humans, Female, Male, Atrial Fibrillation, Aged, Biomarkers, Phenotype, Risk Assessment, Middle Aged, Prospective Studies, Cardiometabolic Risk Factors, Predictive Value of Tests, Prognosis, Time Factors, Aged, 80 and over, Europe, Humans, Atrial Fibrillation, Prognosis, Risk Assessment, Prospective Studies, Predictive Value of Tests, Phenotype, Time Factors, Aged, Aged, 80 and over, Middle Aged, Europe, Female, Male, Biomarkers, Cardiometabolic Risk Factors, Atrial fibrillation, Stroke, Metabolism, Biomolecules, Heart failure, Risk prediction, 1102 Cardiorespiratory Medicine and Haematology, Cardiovascular System & Hematology | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
SGUL Research Institute / Research Centre: | ?? 61 ?? | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Journal or Publication Title: | Cardiovasc Res | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
ISSN: | 1755-3245 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Language: | eng | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Publisher License: | Creative Commons: Attribution-Noncommercial 4.0 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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PubMed ID: | 38613511 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Web of Science ID: | WOS:001215519900001 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Go to PubMed abstract | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
URI: | https://openaccess.sgul.ac.uk/id/eprint/116426 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Publisher's version: | https://doi.org/10.1093/cvr/cvae067 |
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