Atrial fibrillation progression and circulating biomarkers: insights from the RACE V study
D K Baron, N L Van Vreeswijk, H J G M Crijns, U Schotten, I C Van Gelder, M RienstraAbstract
Background
Atrial fibrillation (AF) often progresses from paroxysmal AF (PAF) to more sustained forms, but the underlying mechanisms that drive AF progression are not well understood, and reliable biomarkers for predicting progression are lacking.
Purpose
We investigated associations between circulating biomarkers and AF progression in patients with PAF in the RACE V study.
Methods
The RACE V study is a prospective, multicenter, observational study including 612 patients with PAF. All patients were continuously monitored using implantable loop recorders. AF progression was defined as (1) progression to persistent or permanent AF, or (2) AF burden increase > 3%, during follow-up. Baseline plasma samples were collected and analyzed using the Explore 384 Cardiometabolic panel (369 proteins). Univariable and multivariable differential expression analyses were performed.
Results
Patients had a median age of 64 (57 – 70) years, 257 (42%) were female, and the median CHA2DS2-VA score was 2 (1 – 3). A total of 108 (5.2%/year) patients had AF progression during a median follow-up of 3.4 (2.8–3.7) years. Univariable differential expression analysis identified 16 biomarkers significantly associated with AF progression, all related to extracellular matrix organization (Figure 1). After adjustment for established risk factors of AF progression (age, sex, heart failure and hypertension presence), NT-proBNP remained significantly associated with AF progression (logFC 0.78; adj. P = 0.011).
Conclusions
In patients with PAF, higher NT-proBNP levels were associated with AF progression after adjustment for established risk factors. While NT-proBNP is widely used as a marker of cardiac stress, its role in predicting AF progression remains uncertain. Further studies are needed to clarify its potential value in this context.