Immunothrombosis and new-onset atrial fibrillation in the general population: the Rotterdam Study,Clinical Research in Cardiology

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Immunothrombosis and new-onset atrial fibrillation in the general population: the Rotterdam Study
Clinical Research in Cardiology ( IF 3.8 ) Pub Date : 2021-09-24 , DOI: 10.1007/s00392-021-01938-4
Martijn J Tilly ₁ , Sven Geurts ₁ , Samantha J Donkel ₂ , M Arfan Ikram ₁ , Natasja M S de Groot ₃ , Moniek P M de Maat ₂ , Maryam Kavousi ₁

Affiliation

Background

Atrial fibrillation (AF) is the most common age-related cardiac arrhythmia. The etiology underlying AF is still largely unknown. At the intersection of the innate immune system and hemostasis, immunothrombosis may be a possible cause of atrial remodeling, and therefore be an underlying cause of AF.

Methods

From 1990 to 2014, we followed participants aged 55 and over, free from AF at inclusion. Immunothrombosis factors fibrinogen, von Willebrand factor, ADAMTS13, and neutrophil extracellular traps (NETs) levels were measured at baseline. Participants were followed until either onset of AF, loss-to-follow-up, or reaching the end-date of 01-01-2014. Cox proportional hazard modelling was used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs), adjusted for cardiovascular risk factors.

Results

We followed 6174 participants (mean age 69.1 years, 57% women) for a median follow-up time of 12.8 years. 364 men (13.7%, incidence rate 13.0/1000 person-years) and 365 women (10.4%, incidence rate 8.9/1000 person-years) developed AF. We found no significant association between markers of immunothrombosis and new-onset AF after adjusting for cardiovascular risk factors [HR 1.00 (95% CI 0.93–1.08) for fibrinogen, 1.04 (0.97–1.12) for von Willebrand factor, 1.00 (1.00–1.01) for ADAMTS13, and 1.01 (0.94–1.09) for NETs]. In addition, we found no differences in associations between men and women.

Conclusion

We found no associations between markers of immunothrombosis and new-onset AF in the general population. Inflammation and immunothrombosis may be associated with AF through other cardiovascular risk factors or predisposing conditions of AF. Our findings challenge the added value of biomarkers in AF risk prediction.

Graphic abstract

中文翻译：

一般人群中的免疫血栓形成和新发心房颤动：鹿特丹研究

背景

心房颤动 (AF) 是最常见的与年龄相关的心律失常。房颤的病因仍然很大程度上未知。在先天免疫系统和止血的交叉点上，免疫血栓形成可能是心房重构的一个可能原因，因此是 AF 的潜在原因。

方法

从 1990 年到 2014 年，我们跟踪了 55 岁及以上的参与者，纳入时没有 AF。在基线测量免疫血栓形成因子纤维蛋白原、血管性血友病因子、ADAMTS13 和中性粒细胞胞外陷阱 (NETs) 水平。随访参与者直到房颤发作、失访或达到 2014 年 1 月 1 日的结束日期。Cox 比例风险模型用于计算风险比 (HR) 和 95% 置信区间 (CI)，并针对心血管危险因素进行了调整。

结果

我们跟踪了 6174 名参与者（平均年龄 69.1 岁，57% 为女性），中位随访时间为 12.8 年。364 名男性（13.7%，发病率 13.0/1000 人年）和 365 名女性（10.4%，发病率 8.9/1000 人年）发展为 AF。在调整心血管危险因素后，我们发现免疫血栓形成标志物与新发 AF 之间没有显着关联 [纤维蛋白原 HR 1.00 (95% CI 0.93–1.08)，von Willebrand 因子 1.04 (0.97–1.12)，1.00 (1.00–1.01) ) 用于 ADAMTS13，1.01 (0.94–1.09) 用于 NET]。此外，我们发现男性和女性之间的关联没有差异。