Inflammation and Coagulation are Two Interconnected Pathophysiological Pathways in Atrial Fibrillation Pathogenesis

Abstract

Introduction

Atrial fibrillation (AF) is associated with elevated levels of clotting factors such as tissue factor (TF) and factor XII (FXII). Various inflammation markers, such as interleukin-6 (IL-6), tumor necrosis factor-α (TNF- α), and high-sensitive C-reactive protein (hs-CRP), have also been associated with AF. This study explores the relationship between inflammation markers and coagulation activity, including their impact on heart structural changes in these patients.

Methods

We observed 283 patients with nonvalvular AF who underwent a complete examination at admission, but only 183 patients have successful cardioversion. As a control group, similar patients without AF were examined. The markers of the coagulation and inflammation were studied by ELISA on the analyzer “Stat Fax 303 Plus”. Studies were conducted using l statistical package SPSS 13.0.

Results

It was revealed that patients with AF had significantly higher levels of hs-CRP, IL-6, and TNF-α and had elevated levels of TF and FXII compared with control group. The moderate correlations were observed between IL-6 and left atrial diameter (LAD), IL-6 and LA stiffness, hs-CRP and left atrial volume (LAV), TF and LAV.

Conclusion

We have demonstrated that patients with AF have the relationship between elevated levels of inflammatory markers and coagulation activity, which contributes to structural atrial remodeling.

Keywords:

• atrial fibrillation
• hs-C reactive protein
• interleukin-6
• tissue factor
• factor XII

Abbreviations

AF, atrial fibrillation; AH, arterial hypertension; BMI, body mass index; BP, blood pressure; DBP, diastolic blood pressure; DT, deceleration time; EF, ejection fraction; HF, heart failure; HR, heart rate; hs-СRP, high-sensitive C-reactive protein; IHD, ischemic heart disease; IL-6, interleukin-6; IVRT, isovolumetric relaxation time; IVST, interventricular septum thickness; FXII, factor XII; LAD, left atrial diameter; LAV, left atrial volume; LA stiffness, left atrial stiffness; LVEDD, left ventricular end-diastolic diameter; LVESD, left ventricular end-systolic diameter; LVPWT, left ventricular posterior wall thickness; SBP, systolic blood pressure; TNF-α, tumor necrosis factor-α; TF, tissue factor.

Ethical Approval of Study Participants

The database is collected from atrial fibrillation patients in the Department of Arrhythmia at the Research Institute of Cardiology named after L. Hovhannisyan (Yerevan, Armenia), approved by the Local Ethical Committee (Protocol no.3 of the 05.11.2022) and with informed consent from the patients.

Acknowledgments

The authors thank the patients who participated in this study and donated their samples, the staff of the Department of Arrhythmia and Immunological laboratory of the Research Institute of Cardiology.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, methodology, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors declare no conflicts of interest in this work.

Additional information

Funding

The work was supported by the Science Committee of MESCS RA, in the frames of the research project №21T-3B328.