Background: Atrial fibrillation (AF) is associated with high risk of stroke preventable by timely initiation of anticoagulation. Currently available screening tools based on ECG are not optimal due to inconvenience and high costs. Aim of this study was to study the diagnostic value of apelin for AF in patients with high risk of stroke. Methods: We designed a multicenter, matched-cohort study. The population consisted of three study groups: a healthy control group (34 patients) and two matched groups of 60 patients with high risk of stroke (AF and non-AF group). Apelin levels were examined from peripheral blood. Results: Apelin was significantly lower in AF group compared to non-AF group (0.694 ± 0.148 vs. 0.975 ± 0.458 ng/ml, p = 0.001) and control group (0.982 ± 0.060 ng/ml, p < 0.001), respectively. Receiver operating characteristic (ROC) analysis of apelin as a predictor of AF scored area under the curve (AUC) of 0.658. Apelin's concentration of 0.969 [ng/ml] had sensitivity = 0.966 and specificity = 0.467. Logistic regression based on manual feature selection showed that only apelin and NT-proBNP were independent predictors of AF. Logistic regression based on selection from bivariate analysis showed that only apelin was an independent predictor of AF. A logistic regression model using repeated stratified K-Fold cross-validation strategy scored an AUC of 0.725 ± 0.131. Conclusions: Our results suggest that apelin might be used to rule out AF in patients with high risk of stroke.
- Publikační typ
- časopisecké články MeSH
Úvod: Cieľom práce bolo u pacientov so závažnou (tesnou) aortovou stenózou (AoS) posúdiť a) vzťah medzi klinickými a niektorými hemodynamickými charakteristikami a koncentráciami natriuretických peptidov (ANP, BNP) a b) užitočnosť týchto hormónov v rozhodovaní o ďalšom terapeutickom postupe. Metódy: U 23 konsekutívnych pacientov (12 mužov, 11 žien; vek 63 +/- 7 rokov) a 20 kontrolných osôb sa urobilo echokardiografické vyšetrenie, 6- minútový záťažový test chôdzou a stanovili sa koncentrácie ANP a BNP v troch vzorkách plazmy pred, ihneď po ukončení testu a 20 min po záťaži. Výsledky: Koncentrácie ANP a BNP u pacientov s AoS vykazovali širokú interindividuálnu variabilitu. Všetky hladiny ANP a BNP boli signifikantne vyššie ako u kontrolných osôb (ANP 1, 2, 3, p < 0,001; BNP 1, 2, 3, p < 0,001). Iba hladina ANP sa signifikantne zvýšila vplyvom cvičenia (ANP 1 vs ANP 2 = 0, 011; ANP 2 vs ANP 3 p = 0, 037). Našli sme významné korelácie medzi vrcholovým aortovým gradientom a BNP 1, 2 (r = 0,821, p < 0,001) a ANP 1, pričom korelácie s BNP boli tesnejšie. Nezistili sme korelácie s plochou aortového ústia a s masou ľavej komory. Hladiny hormónov boli nesignifikantne zvýšené v závislosti od NYHA klasifikácie. Cvičenie nezvýšilo validitu stanovenia ANP a BNP. Ich hodnoty mali vysokú senzitivitu, ale nízku špecificitu v detekovaní kritickej AoS. Záver: ANP a hlavne BNP dokázali vylúčiť závažnú AoS, ale neboli vhodné na odhalenie nižších, hraničných gradientov. Význam ANP a BNP pri rozhodovaní o "timingu" operácie AoS bol v našom súbore nepreukázaný.
Introduction: The aim of this research was to, in patients with severe (tight) aortic stenosis (AoS), evaluate a) an association between clinical and some haemodynamic characteristics and natriuretic peptides (ANP, BNP) concentrations and b) usefulness of these hormones in the decision making on the next therapeutic steps. Methods: Echocardiography and 6- minut exertion walking test were performed in 23 consecutive patients (12 men, 11 women; age 67 ± 7 years) and 20 controls together with ANP and BNP measurements from three plasma samples before, immediately after and 20 minutes after the exertion test. Results: There was high inter‑ individual variability in the ANP and BNP concentrations in patients with AoS. All ANP and BNP were significantly higher than in the controls (ANP 1, 2, 3, p < 0.001; BNP 1, 2, 3, p < 0.001). Only the ANP levels increased significantly after the exercise (ANP 1 vs. ANP 2 = 0.011; ANP 2 vs. ANP 3 p = 0.037). We identified significant correlations between aortic peak gradient and BNP 1, 2 (r = 0.821, p < 0.001) and ANP 1, with BNP correlations being stronger. We did not find any correlations with aortic valve area and the left ventricle mass. The hormone levels were non‑significantly increased depending on NYHA classification. Exercise did not improve validity of ANP and BNP measurement. Their values had high sensitivity but low specificity in detecting critical AoS. Conclusion: ANP and mainly BNP helped to exclude severe AoS but they were not useful in detecting lower, borderline gradients. We did not prove ANP and BNP to be significant factors in decision making about the timing of AoS surgery.
- MeSH
- antioxidancia fyziologie MeSH
- finanční podpora výzkumu jako téma MeSH
- kardiotonika terapeutické užití MeSH
- koronární jednotky MeSH
- látky reagující s kyselinou thiobarbiturovou MeSH
- lidé středního věku MeSH
- lidé MeSH
- následné studie MeSH
- oxidační stres MeSH
- transplantace srdce MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- Publikační typ
- srovnávací studie MeSH
- MeSH
- eozinofilie epidemiologie etiologie MeSH
- epidemický výskyt choroby MeSH
- incidence MeSH
- lidé MeSH
- sérologické testy statistika a číselné údaje MeSH
- Trichinella imunologie izolace a purifikace MeSH
- trichinelóza diagnóza epidemiologie parazitologie MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Geografické názvy
- Slovenská republika MeSH
- MeSH
- biologické markery MeSH
- infarkt myokardu MeSH
- kreatinkinasa MeSH
- lidé MeSH
- peroperační komplikace MeSH
- troponin I MeSH
- troponin MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH