Circulating BMP10 Levels Associate With Late Postoperative Atrial Fibrillation and Left Atrial Endomysial Fibrosis

Joris Winters; Michal J Kawczynski; Martijn D Gilbers; Aaron Isaacs; Stef Zeemering; Elham Bidar; Bart Maesen; Michiel Rienstra; Isabelle van Gelder; Sander Verheule; Jos G Maessen; Ulrich Schotten

doi:10.1016/j.jacep.2024.03.003

Circulating BMP10 Levels Associate With Late Postoperative Atrial Fibrillation and Left Atrial Endomysial Fibrosis

JACC Clin Electrophysiol. 2024 Apr 1:S2405-500X(24)00184-1. doi: 10.1016/j.jacep.2024.03.003. Online ahead of print.

Authors

Affiliations

¹ Department of Physiology, Maastricht University, Maastricht, the Netherlands; Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands.
² Department of Physiology, Maastricht University, Maastricht, the Netherlands; Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands; Department of Cardiothoracic Surgery, Heart and Vascular Centre Maastricht University Medical Centre, Maastricht, the Netherlands.
³ Department of Physiology, Maastricht University, Maastricht, the Netherlands.
⁴ Department of Physiology, Maastricht University, Maastricht, the Netherlands; Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands; Maastricht Centre for Systems Biology, University Maastricht, Maastricht, the Netherlands.
⁵ Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands; Department of Cardiothoracic Surgery, Heart and Vascular Centre Maastricht University Medical Centre, Maastricht, the Netherlands.
⁶ Department of Cardiology, University of Groningen, University Medical Centre, Groningen, the Netherlands.
⁷ Department of Physiology, Maastricht University, Maastricht, the Netherlands; Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands. Electronic address: schotten@maastrichtuniversity.nl.

PMID: 38639699
DOI: 10.1016/j.jacep.2024.03.003

Abstract

Background: Serum bone morphogenetic protein 10 (BMP10) blood levels are a marker for history of atrial fibrillation (AF) and for major adverse cardiovascular events in patients with AF, including stroke, AF recurrences after catheter ablations, and mortality. The predictive value of BMP10 in patients undergoing cardiac surgery and association with morphologic properties of atrial tissues are unknown.

Objectives: This study sought to study the correlation between BMP10 levels and preoperative clinical traits, occurrence of early and late postoperative atrial fibrillation (POAF), and atrial fibrosis in patients undergoing cardiac surgery.

Methods: Patients with and without preoperative AF history undergoing first cardiac surgery were included (RACE V, n = 147). Preoperative blood biomarkers were analyzed, left (n = 114) and right (n = 125) atrial appendage biopsy specimens were histologically investigated after WGA staining, and postoperative rhythm was monitored continuously with implantable loop recorders (n = 133, 2.5 years).

Results: Adjusted multinomial logistic regression indicated that BMP10 accurately reflected a history of persistent AF (OR: 1.24, 95% CI: 1.10-1.40, P = 0.001), similar to NT-pro-BNP. BMP10 levels were associated with increased late POAF₉₀ occurrence after adjustment for age, sex, AF history, and early POAF occurrence (HR: 1.07 [per 0.1 ng/mL increase], 95% CI: 1.00-1.14, P = 0.041). Left atrial endomysial fibrosis (standardized β = 0.22, P = 0.041) but not overall fibrosis (standardized Β = 0.12, P = 0.261) correlated with circulating BMP10 after adjustment for age, sex, AF history, reduced LVF, and valvular surgery indication.

Conclusions: Increased BMP10 levels were associated with persistent AF history, increased late POAF incidence, and LAA endomysial fibrosis in a diverse sample of patients undergoing cardiac surgery.

Keywords: BMP10; atrial fibrillation; atrial fibrosis; cardiac surgery; postoperative atrial fibrillation.