Increased parathyroid hormone concentration as a biomarker of atrial fibrillation in severe aortic stenosis.

BACKGROUND

Atrial fibrillation (AF) is commonly observed in patients with aortic stenosis and comorbidities. Abnormal parathyroid hormone (PTH) concentration has been observed in heart failure.

AIMS: We aimed to evaluate a potential association between increased concentration of PTH and AF in patients with severe aortic stenosis.

MATERIAL AND

METHODS

Patients with severe aortic stenosis and heart failure were included. Demographic, clinical, and laboratory data were collected. Patients were assigned to the AF and the sinus rhythm groups.

RESULTS

The study group comprised 106 consecutive patients (57 females [53.8%], median [interquartile range] age of 77 [72-82] years). All patients presented with severe aortic stenosis, with a median (interquartile range) peak transvalvular gradient of 86.5 (71-102.8) mm Hg. Left atrial diameter over 40 mm was found in 76 (71.7%) patients. A history of AF was identified in 39 patients (36.8%). Patients with any form of AF were characterized by an increased concentration of PTH compared to patients with sinus rhythm (P = 0.03). Patients with and without impaired kidney function had different PTH concentrations (P <0.001). After adjustment of clinical and echocardiographic data in multivariable analysis, only PTH concentration (P = 0.02; OR, 1.02; 95% CI, 1.00-1.03) together with left atrial diameter (P = 0.008; OR, 1.13; 95% CI, 1.03-1.23), with area under the curve of 0.752, 43.3% sensitivity, 90% specificity, remained significant predictors of AF. The cut-off value for PTH concentration over 84.1 pg/ml was predictive of paroxysmal AF.

CONCLUSIONS

Increased PTH concentration may characterize AF patients. Patients with aortic stenosis presenting with PTH concentration over 84 pg/ml should be screened for paroxysmal AF.