Combined Effect of Homocysteine and Uric Acid to Identify Patients With High Risk for Subclinical Atrial Fibrillation.
Combined Effect of Homocysteine and Uric Acid to Identify Patients With High Risk for Subclinical Atrial Fibrillation.
复制标题
同型半胱氨酸和尿酸的联合作用可识别亚临床心房颤动高风险患者
DOI：
10.1161/jaha.121.021997
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发表时间：
2022-01-04
影响因子：
5.4
通讯作者：
Xia, Yunlong
中科院分区：
文献类型：
--
作者：
Wang, Shihao;Wei, Yushan;Hidru, Tesfaldet Habtemariam;Li, Daobo;Wang, Nan;Yang, Yiheng;Wang, Yunsong;Yang, Xiaolei;Xia, Yunlong
亚临床房颤（SCAF）通常无症状，但有害。在植入心脏植入式电子设备的患者中，我们评估了同型半胱氨酸和尿酸（UA）生物标志物的联合性能，以区分SCAF的高风险患者。我们在2013年1月至2019年12月期间在中国大连入组了1224例连续患者，以评价心脏植入式电子器械患者的SCAF。从根据是否存在>6分钟的心房高速率发作选择的患者中获得临床数据和血液样本。采集血液样本，检测所有患者的同型半胱氨酸和UA生物标志物，以区分其SCAF的预后表现。SCAF与无SCAF患者同型半胱氨酸和UA生物标志物显著不同。在多变量考克斯回归分析与潜在的混杂因素，升高同型半胱氨酸和UA生物标志物与SCAF的风险增加显着相关。无论男性和女性的UA水平如何，同型半胱氨酸（5.7 μmol/L）升高1 SD与SCAF风险增加相关。同样，UA（91 μmol/L）增加1-SD与男性（风险比，1.81; 95% CI，1.43-2.30）和女性（风险比，2.11; 95% CI，1.69-2.62）中高水平同型半胱氨酸患者的SCAF风险增加相关。将同型半胱氨酸和UA添加到2020年欧洲心脏病学会指南推荐的房颤风险因素中，显著改善了SCAF的风险识别。同型半胱氨酸和UA生物标志物与SCAF密切相关。通过添加选定的生物标志物，欧洲心脏病学会SCAF模型的预测性能得到提高。URL：https://www.chictr.org.cn;唯一标识符：Chi-CTR 200003837。
Subclinical atrial fibrillation (SCAF) is often asymptomatic nonetheless harmful. In patients with cardiac implantable electronic devices, we evaluated the combined performance of homocysteine and uric acid (UA) biomarkers to discriminate high‐risk patients for SCAF. We enrolled 1224 consecutive patients for evaluation of SCAF in patients with cardiac implantable electronic devices in Dalian, China, between January 2013 and December 2019. Clinical data and blood samples were obtained from patients selected according to the absence or presence of atrial high‐rate episodes >6 minutes. Blood samples were obtained, and homocysteine and UA biomarkers were tested in all patients to distinguish their prognostic performance for SCAF. Homocysteine and UA biomarkers were significantly different in SCAF versus no SCAF. On multivariable Cox regression analysis with potential confounders, elevated homocysteine and UA biomarkers were significantly associated with an increased risk of SCAF. A rise of 1 SD in homocysteine (5.7 μmol/L) was associated with an increased risk of SCAF in men and women regardless of their UA levels. Similarly, a 1‐SD increase in UA (91 μmol/L) was associated with an increased risk of SCAF among the patients with high levels of homocysteine in men (hazard ratio, 1.81; 95% CI, 1.43–2.30) and women (hazard ratio, 2.11; 95% CI, 1.69–2.62). The addition of homocysteine and UA to the atrial fibrillation risk factors recommended by the 2020 European Society of Cardiology Guidelines significantly improved risk discrimination for SCAF. Homocysteine and UA biomarkers were strongly associated with SCAF. The prediction performance of the European Society of Cardiology model for SCAF was increased by the addition of the selected biomarkers. URL: https://www.chictr.org.cn; Unique identifier: Chi‐CTR200003837.