Cardiac Biomarkers and Risk of Atrial Fibrillation in Chronic Kidney Disease: The CRIC Study
Cardiac Biomarkers and Risk of Atrial Fibrillation in Chronic Kidney Disease: The CRIC Study
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DOI：
10.1161/jaha.119.012200
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发表时间：
2019-08-06
影响因子：
5.4
通讯作者：
Townsend, Raymond R.
中科院分区：
文献类型：
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作者：
Lamprea-Montealegre, Julio A.;Zelnick, Leila R.;Townsend, Raymond R.
背景-我们在一项慢性肾脏病患者的前瞻性研究中检测了心肌伸展、损伤、炎症和纤维化的心脏生物标志物与房颤（AF）发生风险的相关性。方法和结果-该研究样本为多中心CRIC（慢性肾功能不全队列）研究中3053名基线时未被确定为AF的慢性肾脏病患者。基线时测量的心脏生物标志物为NT-proBNP（N末端B型利钠肽前体）、高敏肌钙蛋白T、半乳糖凝集素-3、生长分化因子-15和可溶性ST-2。突发性房颤（"房颤事件"）定义为因房颤住院治疗。在中位随访8年期间，279例（9%）参与者发生了新的房颤事件。在校正模型中，较高的基线对数转换NT-proBNP（N末端B型利钠肽前体）与AF事件相关（根据SD较高浓度校正的风险比[HR]：2.11; 95% CI，1.75，2.55），对数高敏肌钙蛋白T也是如此（HR 1.42; 95% CI，1.20，1.68）。这些关联在分类分析中显示出剂量-反应关系。尽管在连续模型中，对数可溶性ST-2与AF风险相关（HR/SD高浓度1.35; 95% CI，1.16，1.58），但在分类分析中，这种相关性并不一致。对数半乳糖凝集素-3（HR 1.05; 95% CI，0.91，1.22）和对数生长分化因子-15（人力资源1.16; 95%CI，0.96，1.40）与房颤事件无显著相关性。（N-末端B型利钠肽前体）和高敏肌钙蛋白T浓度，以及慢性肾脏疾病参与者大队列中AF事件的风险。心房心肌牵张增加和心肌细胞损伤可能与慢性肾脏疾病患者AF的高负荷有关。
Background-We tested associations of cardiac biomarkers of myocardial stretch, injury, inflammation, and fibrosis with the risk of incident atrial fibrillation (AF) in a prospective study of chronic kidney disease patients.Methods and Results-The study sample was 3053 participants with chronic kidney disease in the multicenter CRIC (Chronic Renal Insufficiency Cohort) study who were not identified as having AF at baseline. Cardiac biomarkers, measured at baseline, were NT-proBNP (N-terminal pro-B-type natriuretic peptide), high-sensitivity troponin T, galectin-3, growth differentiation factor-15, and soluble ST-2. Incident AF ("AF event") was defined as a hospitalization for AF. During a median follow-up of 8 years, 279 (9%) participants developed a new AF event. In adjusted models, higher baseline log-transformed NT-proBNP (N-terminal pro-B-type natriuretic peptide) was associated with incident AF (adjusted hazard ratio [HR] per SD higher concentration: 2.11; 95% CI, 1.75, 2.55), as was log-high-sensitivity troponin T (HR 1.42; 95% CI, 1.20, 1.68). These associations showed a dose- response relationship in categorical analyses. Although log-soluble ST-2 was associated with AF risk in continuous models (HR per SD higher concentration 1.35; 95% CI, 1.16, 1.58), this association was not consistent in categorical analyses. Log-galectin-3 (HR 1.05; 95% CI, 0.91, 1.22) and log-growth differentiation factor-15 (HR 1.16; 95% CI, 0.96, 1.40) were not significantly associated with incident AF.Conclusions-We found strong associations between higher NT-proBNP (N-terminal pro-B-type natriuretic peptide) and high-sensitivity troponin T concentrations, and the risk of incident AF in a large cohort of participants with chronic kidney disease. Increased atrial myocardial stretch and myocardial cell injury may be implicated in the high burden of AF in patients with chronic kidney disease.