The Role of Extracellular Matrix and Inflammation in the Stratification of Bleeding and Thrombotic Risk of Atrial Fibrillation on Oral Anticoagulant Therapy: Insights from Strat-Af Study
Articolo
Data di Pubblicazione:
2023
Citazione:
The Role of Extracellular Matrix and Inflammation in the Stratification of Bleeding and Thrombotic Risk of Atrial Fibrillation on Oral Anticoagulant Therapy: Insights from Strat-Af Study / F. Alfano, F. Cesari, A. Maria Gori, M. Berteotti, E. Salvadori, B. Giusti, A. Bertelli, A. Kura, C. Barbato, B. Formelli, F. Pescini, E. Fainardi, S. Chiti, C. Marzi, S. Diciotti, R. Marcucci, A. Poggesi. - In: JOURNAL OF CLINICAL MEDICINE. - ISSN 2077-0383. - 12:21(2023), pp. 6866.1-6866.15. [10.3390/jcm12216866]
Abstract:
In anticoagulated atrial fibrillation (AF) patients, the validity of models recommended for
the stratification of the risk ratio between benefits and hemorrhage risk is limited. We hypothesize
that both circulating and neuroimaging-based markers might improve the prediction of bleeding
and thrombotic risk in anticoagulated AF patients. The Strat-AF study is an observational, prospec-
tive, single-center study enrolling 170 patients with AF; recruited patients are evaluated by means
of a comprehensive protocol, with clinical, cerebral magnetic resonance imaging and circulating
biomarkers assessment. The main outcome is the evaluation of cerebral microangiopathy related
to the levels of circulating biomarkers of inflammation and extracellular matrix (ECM) remodeling.
At multivariate logistic regression analysis adjusted for age, sex, CHA2DS2-VASc, HAS-BLED and
type of anticoagulant, matrix metalloproteinases (MMP)-2 levels were significantly and positively
associated with the presence of cerebral microbleeds (CMBs). A significant association between
MMP-2, tissue inhibitor of metalloproteinases (TIMP)-1,-2,-4 levels and white matter hyperintensity
was also found. Concerning the small vessel disease (SVD) score, MMP-2 and TIMP-1,-2 levels were
associated with the presence of two and three or more signs of SVD, whereas TIMP-4 levels were
associated with the presence of three signs of SVD with respect to patients with no instrumental signs
of SVD. As regarding the presence of enlarged perivascular spaces (EPVS), a significant association
was found for high levels of interleukin (IL)-8 and TIMP 1-2-3. These results demonstrate that
patients with AF have evidence of impaired ECM degradation, which is an independent risk factor
for thrombotic complications of AF patients on oral anticoagulant therapy. The incorporation of these
markers in the prognostic schemes might improve their clinical capability in predicting stroke risk
and thrombotic complications.
Tipologia IRIS:
01 - Articolo su periodico
Keywords:
atrial fibrillation; biomarkers; extracellular matrix; cerebral infarcts; hyperintensities of white matter; SVDs; cerebral microbleeds; EPVS
Elenco autori:
F. Alfano, F. Cesari, A. Maria Gori, M. Berteotti, E. Salvadori, B. Giusti, A. Bertelli, A. Kura, C. Barbato, B. Formelli, F. Pescini, E. Fainardi, S. Chiti, C. Marzi, S. Diciotti, R. Marcucci, A. Poggesi
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