Predictors of atrial fibrillation development in patients with chronic cardiorenal syndrome

Objective

To identify predictors of the development of permanent atrial fibrillation in patients with chronic cardiorenal syndrome.

Materials and Methods

A total of 282 patients with chronic cardiorenal syndrome were examined. Inclusion criteria were confirmed chronic heart failure (LV EF <50%, structural heart abnormalities, NT-proBNP >125 ng/ml); chronic kidney disease (eGFR <60 ml/min/1.73 or albumin excretion A2-A3 for >3 months); sinus heart rhythm. A detailed assessment was made of the structural and functional state of the heart, renal function (including cystatin C and albumin excretion), fibrosis and systemic inflammation activity using TIMP-1 and sST2, and global arterial wall function using PWVao. The median follow-up was 18 [15; 23] months.

Results

The average age of patients was 58.4±11.3 years. Among 27 candidate parameters that demonstrated a correlation with the development of permanent AF in patients with cardiorenal syndrome, 4 predictors were identified (Fig.1). The highest predictive value for the risk of developing permanent AF in patients with cardiorenal syndrome was shown by sST2 >65 ng/ml (sensitivity 83.3, specificity 97.9, AUC 0.938), NT-proBNP >581 ng/ml (sensitivity 76.4, specificity 97.9, AUC 0.919), TIMP-1 >105 ng/ml (sensitivity 78.2, specificity 93.5, AUC 0.907), PWVao >8.0 m/s (sensitivity 94.5, specificity 97.9, AUC 0.987).

In patients with cardiorenal syndrome, the risk of developing permanent AF with an increase in NT-proBNP> 581 pg/ml increases 3-fold (OR 1.880 (95% CI (1.543; 10.900)), with an increase in the concentration of sST2> 65 ng/ml - 6-fold (OR 5.846 (95% CI (3.250; 20.877), p <0.001), PWVao> 8 m/s, the presence of which contributes to a 6-fold increase in the risk of developing permanent AF (OR 6.044 (95% CI (2.905; 12.575), p <0.001) and the concentration of TIMP-1> 105 ng/dl, which contributes to an almost 2-fold increase in the risk of developing AF (OR 1.607 (95% CI (0.806; 3.205), p<0.001).

Conclusions

in patients with chronic cardiorenal syndrome, a moderate increase in NT-proBNP > 581 ng/ml, sST2 > 65 ng/ml, TIMP-1 > 105 ng/ml, PWVao > 8.0 m/s are predictors of future permanent AFFig. 1Predictors of permanent AF