P2670Plasma renalase concentration in patients with atrial fibrillation undergoing pulmonary vein isolation

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Purpose: The purpose of the study was to evaluate plasma renalase concentration, with relation to numerous clinical, echocardiographic and hemostatic parameters, in patients with atrial fibrillation (AF) undergoing percutaneous radiofrequency pulmonary vein isolation (PVI). Methods: This observational study covered 69 consecutive patients (median age 58 (50; 62) years; 46 men (67%)) with either paroxysmal (n=62, 89%) or persistent AF (n=7, 11%), who were submitted to PVI. Blood was withdrawn from peripheral vein directly before PVI and assayed for plasma renalase using ELISA method. Pre-procedural left atrial (LA) blood thrombogenicity was established in random 39 patients using rotational thromboelastography by EXTEM and FIBTEM tests. Transthoracic ultrasonography with strain imaging and 24-hour electrocardiographic monitoring were performed prior to procedure. Results: Peripheral renalase levels were lower in patients with persistent than paroxysmal AF (19048 vs. 28766 ng/mL; p=0.023). Patients with episodes of AF directly preceding PVI had lower plasma renalase level (24496 vs. 29656 ng/mL; p=0.04) and simultaneously had shorter EXTEM (77 vs. 95 s, p<0.0001) and FIBTEM clotting time (CT; 68.6 vs. 91.1 s, p=0.001) and greater LA volume index (31.5 vs. 25.0 ml/m2, p=0.041) and less negative global 4-chamber LA strain (-10.9 vs. -14.2, p=0.03). Patients with plasma renalase within first quartile were characterized by higher rate of persistent AF (OR=6.86, p=0.036) and lower FIBTEM-derived CT (72.7 vs. 91.9 s, p=0.007). Plasma renalase inversely correlated with mean initial 24-hour heart rate (r= -0.24, p=0.046), maximal AF heart rate (r= -0.42, p=0.049), AF burden (r= -0.32, p=0.023), LA diameter (r= -0.29, p=0.02), global 4-chamber LA strain (r= -0.36, p=0.008), and positively corresponded with both EXTEM- (r=0.40; p=0.014) and FIBTEM-derived CT (r=0.54; p=0.0004), and mean platelet volume (r=0.25, p=0.038). Multivariate regression revealed that global 4-chamber LA strain was the only independent predictor of renalase variability (b=-0.42, p=0.045, R2=0.18).

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