Impact of Inflammation on Atrial Fibrillation in patients with Metabolic Syndrome

Abstract BACKGROUND: Inflammation have been involved in the pathogenesis of both metabolic syndrome(MS) and atrial fibrillation(AF). The magnitude of elevations in plasma C-reactive protein(CRP) a marker of inflammation, is probably related to atrial structural remodeling and impaired atrial function.In patient with MS,limited data exist regarding impact of plasma levels of inflammatory markers,such as C-reactive protein on the: type of AF and atrial structural and functional remodeling. OBJECTIVE: We set to analyze the impact of degree of systemic inflammation (assessed acrording to CRP levels),on the type of AF,atrial functional and structural remodeling in patients with MS.METHODS: We conducted an multicenter observational cross-sectional study. Recruited were 425 consecutive participants,with MS and AF(paroxysmal, persistent and permanent AF),who attended outpatient visits at 7 general cardiology Health Care Clinics, during 1 calendar year,stratified according CRP-levels:(211 participans with level of CRP ≥3mg/l, and 214, with level of CRP <3mg/l). RESULTS: Permanent type of AF, was more common in participans with CRP-levels ≥3mg/l(54.6% vs.20.5%,p= 0.000),whereas parhoxysmal AF, was more common in participans with CRP-levels of <3 mg/l (9.9% vs.52.3%,p=0.000).Patients who had CRP levels above the cut-off of 3 mg/l,had increased dimension of left atrium{(LA),(4.2±0.3 vs. 3.7±0.2,p=0.000)},higher prevalence of enlargement of LA {defined as left atrial volum index(LAVI) ≥29ml/m2(84.1% vs.48.5%,p=0.002)} and inverse relationship of LA function(defined as left atrial emptying fraction(LAEF <45%, (30.8±3.4 vs.41.9±2.6, p=0.00). There was observed significant association of CRP levels above the cut-off of 3 mg/l and: frequence of persistent AF(OR=8.824,95% CI 1.689-46.100), permanent AF(OR=13.955, 95%CI 2.676 -72.780),increased LA dimension (OR=3.817,95% CI 0.989 -1.544), and decreased LA function.{(expressed by: LAVI >29ml/m2OR=4.014, 95% CI 2.620-6.152),LAEF <45%(OR=3.323,95%CI 2.062 -5.351) and LAVI>29 + LAEF-reduced (OR=3.354,95% CI 1.693 - 6.646)}.CONCLUSIONS: In patients with Metabolic Syndrome,degree of systemic inflammation have significant impact on clinical presentation of Atrial Fibrillation,atrial functional and structural remodeling .