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A prognostic nomogram for event-free survival in patients with atrial fibrillation before cardiac resynchronization therapy.

ABSTRACT: BACKGROUND:Atrial fibrillation (AF), one of the most common comorbidities of heart failure (HF), is associated with worse long-term prognosis in HF patients receiving cardiac resynchronization therapy (CRT). However, there is still no convenient tool to identify CRT candidates with AF who are at high risk of mortality and hospitalization due to HF. METHODS:We included 152 consecutive patients with AF for CRT in our hospital from January 2009 to July 2019. Multiple imputation was used for missing values. With imputed datasets, a multivariate Cox regression model was performed for variable selection using the backward stepwise method to predict all-cause mortality and HF readmissions. A nomogram and nomogram-based scoring system were constructed from the selected predictors. Then, internal validation and calibration were achieved by the bootstrap method, deriving the corrected concordance index and calibration curves. Sensitivity analysis was also performed to validate our selected predictors. RESULTS:Five predictors were incorporated in the nomogram, including N-terminal pro brain natriuretic protein (NT-proBNP)?>?1745?pg/mL, history of syncope, previous pulmonary hypertension, moderate or severe tricuspid regurgitation, thyroid-stimulating hormone (TSH)?>?4 mIU/L. The concordance index (0.70, 95% CI 0.62-0.77), corrected concordance index (0.67, 95% CI 0.59-0.74) and calibration curve showed optimal discrimination and calibration of the established nomogram. A significant difference in overall event-free survival was recognized by the nomogram-derived scores for patients with high risk (>?50 points), intermediate risk (21-50 points) and low risk (0-20 points) before CRT. CONCLUSION:Our internally validated nomogram may be an applicable tool for the early risk stratification of CRT candidates with AF.

SUBMITTER: Cai M

PROVIDER: S-EPMC7222436 | biostudies-literature | 2020 May

REPOSITORIES: biostudies-literature

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A prognostic nomogram for event-free survival in patients with atrial fibrillation before cardiac resynchronization therapy.

Cai Minsi M Hua Wei W Zhang Nixiao N Yang Shengwen S Hu Yiran Y Gu Min M Niu Hongxia H Zhang Shu S

BMC cardiovascular disorders 20200513 1

<h4>Background</h4>Atrial fibrillation (AF), one of the most common comorbidities of heart failure (HF), is associated with worse long-term prognosis in HF patients receiving cardiac resynchronization therapy (CRT). However, there is still no convenient tool to identify CRT candidates with AF who are at high risk of mortality and hospitalization due to HF.<h4>Methods</h4>We included 152 consecutive patients with AF for CRT in our hospital from January 2009 to July 2019. Multiple imputation was u ...[more]

PMID: 32404049

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Project description:Atrial fibrillation (AF) is the most common sustained arrhythmia characterized by rapid and multiple irregular excitations within the atria. AF is associated with serious morbidity and increased mortality, and its prevalence is prospected to increase as society ages. The limited therapeutic efficacy of AF treatment as well as its high socioeconomic burden makes AF a major clinical challenge. Despite our expanding knowledge of individual proteins and pathways involved in the complex pathophysiology of atrial fibrillation (AF), an unbiased overview of proteins and functionally enriched biological processes as well as their crosstalk is lacking. Here, we performed an explorative proteomics analysis to reveal the global abundance of proteins in cardiac tissue of patients, and deciphered functionally grouped gene ontologies (GO) to uncover a perspective of the disease biology driving or driven by AF. A total of 2703 proteins were identified by liquid chromatography coupled to tandem mass spectrometry. Among them, 150 proteins (accounting for 5.6% of 2703) had a significantly altered abundance (100 proteins increased and 50 decreased) in AF. A significant biological connection was found between those (protein-protein interaction enrichment p-value=1.0e-16). GO enrichment analysis showed that these 150 proteins were mainly located in extracellular/cytoplasmic vesicles, mitochondrion, and cytoskeletal compartments. Correspondingly, the 100 proteins increased in AF were significantly enriched in the GO terms related to immune system, metabolic process, iron process, ECM disassembly, mitochondrial translation and apoptotic signaling. Partially clustered proteins with dense functional link were found in immune system and metabolic process, and were respectively annotated in neutrophil degranulation, and oxoacid metabolic process coupled to the subunits of mitochondrial dehydrogenase NADH. Those processes enriched in AF had crosstalk via the proteins involved in neutrophil degranulation. Selected proteins such as LCN2 (neutrophil degranulation), CA3 (immune system), NDUFS2 (complex I) and MYH10 (actin motor protein) were validated by western blot or qPCR in an independent cohort. The 50 proteins decreased in AF were collectively enriched in vesicle-mediated transport and actin filament-based movement. We demonstrate that important biological processes underlying persistent AF as well as their crosstalk via the components of neutrophil degranulation. Our study provides a novel insight for a more efficient targeting strategy for AF treatment.

Dataset Information

A prognostic nomogram for event-free survival in patients with atrial fibrillation before cardiac resynchronization therapy.

Publications

A prognostic nomogram for event-free survival in patients with atrial fibrillation before cardiac resynchronization therapy.

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