Korean Circ J.  2017 Sep;47(5):752-761. 10.4070/kcj.2017.0024.

Discordant Relationships between Systemic Inflammatory Markers and Burden of Oxidative Stress in Patients with Atrial Fibrillation

• Nam JH
• Park KH
• Lee JH
• Lee CH
• Son JW
• Kim U
• Park JS
• Shin DG

• KMID: 2389607
• DOI: http://doi.org/10.4070/kcj.2017.0024

Abstract

BACKGROUND AND OBJECTIVES
Oxidative stress (OS) plays an important role in the pathophysiology of atrial fibrillation (AF) by amplifying the inflammatory cascade, wherein augmented inflammation facilitates the atrial electrical remodeling process. Few studies have investigated the possible link between systemic inflammation and OS in AF.
SUBJECTS AND METHODS
A total of 220 consecutive patients with AF (117 patients) or healthy controls (103 patients) were enrolled. Among the 117 AF patients, 65 paroxysmal AF (PaAF) and 52 persistent AF (PeAF) patients were included. The level of 8-iso-prostaglandin F2α (8-iso-PGF2α) was measured as a marker of OS burden. We evaluated the correlations between 3 systemic inflammatory markers, high-sensitivity C-reactive protein (hsCRP), neutrophil to lymphocyte ratio (NLR), and red cell distribution width (RDW), and 8-iso-PGF2α.
RESULTS
The 8-iso-PGF2α concentration in both PaAF and PeAF patients was higher than that of controls (p<0.001 and p=0.024, respectively). The NLR and RDW of PeAF patients were higher than those of both control and PaAF patients (p=0.041 and p=0.031 for NLR, p=0.057 and p=0.031 for RDW, respectively). There were no correlations between specific inflammatory markers and the 8-iso-PGF2α in AF. The 8-iso-PGF2α level decreased gradually with an increase in AF duration (p=0.008), contrary to the graded increase in hsCRP. Multiple regression analysis indicated that AF duration persisted as a significant determinant of 8-iso-PGF2α (β=−0.249, p=0.044).
CONCLUSION
Systemic inflammatory marker levels were not proportional to the levels of 8-iso-PGF2α, an OS marker, in AF.

Keyword

Atrial fibrillation; Inflammation; Oxidative stress

MeSH Terms

Atrial Fibrillation*
Atrial Remodeling
C-Reactive Protein
Erythrocyte Indices
Humans
Inflammation
Lymphocytes
Neutrophils
Oxidative Stress*
C-Reactive Protein

Figure

• 

  Figure 1 Box plots depicting the differences in 8-iso-PGF2α level and systemic inflammatory markers between the No AF and AF subgroups. 8-iso-PGF2α = 8-iso-prostaglandin F2α; AF = atrial fibrillation; lnhsCRP = natural log-transformed high-sensitivity C-reactive protein; NLR = neutrophil to lymphocyte ratio; PaAF = paroxysmal atrial fibrillation; PeAF = persistent atrial fibrillation; RDW = red cell distribution width. *p<0.05.

• 

  Figure 2 The changes in 8-iso-PGF2α and lnhsCRP levels according to quartile of AF duration. The graph is expressed as the mean±SD. AF duration was graded as 1st quartile (≤3 months), 2nd quartile (3–12 months), 3rd quartile (12–39 months), and 4th quartile (>39 months) in the AF group. 8-iso-PGF2α = 8-iso-prostaglandin F2α; AF = atrial fibrillation; lnhsCRP = natural log-transformed high-sensitivity C-reactive protein; SD = standard deviation.

• 

  Figure 3 Scatterplots depicting the relationship between the 8-iso-PGF2α and systemic inflammatory markers in AF; (A) 8-iso-PGF2α vs. hsCRP, (B) 8-iso-PGF2α vs. NLR, and (C) 8-iso-PGF2α vs. RDW. 8-iso-PGF2α = 8-iso-prostaglandin F2α; AF = atrial fibrillation; hsCRP = high-sensitivity C-reactive protein; lnhsCRP = natural log-transformed high-sensitivity C-reactive protein; NLR = neutrophil to lymphocyte ratio; RDW = red cell distribution width.

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