Evidence mapPaperPMID 39215973Full record

Trial reportEuropean heart journal2024

Biomarker-based prediction of sinus rhythm in atrial fibrillation patients: the EAST-AFNET 4 biomolecule study.

Larissa Fabritz, Christoph Al-Taie, Katrin Borof, Günter Breithardt, A John Camm, Harry J G M Crijns, Victor Roth Cardoso, Winnie Chua, Silke van Elferen, Lars Eckardt and 17 more

Abstract readMulticenter StudyRandomized Controlled Trial
In one paragraph

Trial report in European heart journal, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 21 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
21citing papers in PubMed, 1 pooled it
field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

21 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Interactions of blood biomolecules with early rhythm control in atrial fibrillation patients: exploratory analysis of the EAST-AFNET 4 biomolecule study.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2026
    Trial
  3. Prevalence and severity of atrial cardiomyopathy in patients with recently diagnosed atrial fibrillation and stroke risk factors and its association with early rhythm control: a secondary analysis of EAST-AFNET 4.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2025
    Trial
  4. Article
  5. Comprehensive assessment of novel cardiovascular biomarkers in AF.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2026
    Article
  6. Article
  7. Article
  8. Review
  9. Article
  10. Transforming atrial fibrillation management by targeting comorbidities and reducing atrial fibrillation burden: the 10th AFNET/EHRA consensus conference.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2025
    Article
  11. Review
  12. A novel technique for vein of Marshall blood sampling and its application in assessing atrial remodeling in atrial fibrillation.Clinical research in cardiology : official journal of the German Cardiac Society · 2025
    Article
  13. Article
  14. Review
  15. Article
  16. Article
  17. Observational
  18. Review
  19. Article
  20. Observational
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

27 authors.

Larissa FabritzUniversity Center of Cardiovascular Science, University Heart and Vascular Center Hamburg, University Medical Center Hamburg Eppendorf, Hamburg, Germany.ORCID 0000-0002-9241-1733
Christoph Al-TaieUniversity Center of Cardiovascular Science, University Heart and Vascular Center Hamburg, University Medical Center Hamburg Eppendorf, Hamburg, Germany.ORCID 0000-0001-7088-3943
Katrin BorofDepartment of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg Eppendorf, Martinistr. 52, Hamburg 20246, Germany.
Günter BreithardtAtrial Fibrillation NETwork (AFNET), Mendelstr. 11, 48149 Münster, Germany.ORCID 0000-0001-7574-8900
A John CammClinical Sciences, St George's University, London, UK.ORCID 0000-0002-2536-2871
Harry J G M CrijnsDepartment of Cardiology, University Hospital Maastricht, Maastricht, The Netherlands.ORCID 0000-0003-1073-5337
Victor Roth CardosoInstitute of Cardiovascular Sciences, Wolfson Drive, University of Birmingham, B15 2TT Birmingham, UK.ORCID 0000-0002-9588-6304
Winnie ChuaInstitute of Cardiovascular Sciences, Wolfson Drive, University of Birmingham, B15 2TT Birmingham, UK.ORCID 0000-0002-6747-8813
Silke van ElferenUniversity Center of Cardiovascular Science, University Heart and Vascular Center Hamburg, University Medical Center Hamburg Eppendorf, Hamburg, Germany.ORCID 0009-0002-4165-9824
Lars EckardtAtrial Fibrillation NETwork (AFNET), Mendelstr. 11, 48149 Münster, Germany.ORCID 0000-0002-3735-8503
Georgios GkoutosUniversity Center of Cardiovascular Science, University Heart and Vascular Center Hamburg, University Medical Center Hamburg Eppendorf, Hamburg, Germany.ORCID 0000-0002-2061-091X
Andreas GoetteAtrial Fibrillation NETwork (AFNET), Mendelstr. 11, 48149 Münster, Germany.ORCID 0000-0002-8223-7209
Eduard GuaschHospital Clinic de Barcelona, Institute of Biomedical Research August Pi Sunyer (IDIBAPS), Hospital Clinic, CIBERCV, University of Barcelona, Catalonia, Spain.ORCID 0000-0003-4238-5319
Stéphane HatemMAESTRIA Consortium, European Union's Horizon 2020 research and innovation programme, agreement number 965286, Sorbonne Université, Paris, France.ORCID 0000-0002-9790-0755
Andreas MetznerDepartment of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg Eppendorf, Martinistr. 52, Hamburg 20246, Germany.ORCID 0000-0002-6818-6396
Lluís MontHospital Clinic de Barcelona, Institute of Biomedical Research August Pi Sunyer (IDIBAPS), Hospital Clinic, CIBERCV, University of Barcelona, Catalonia, Spain.ORCID 0000-0002-8115-5906
Vaishnavi Ameya MurukutlaUniversity Center of Cardiovascular Science, University Heart and Vascular Center Hamburg, University Medical Center Hamburg Eppendorf, Hamburg, Germany.ORCID 0000-0001-9455-3391
Julius ObergasselUniversity Center of Cardiovascular Science, University Heart and Vascular Center Hamburg, University Medical Center Hamburg Eppendorf, Hamburg, Germany.ORCID 0000-0002-3905-0203
Andreas RilligDepartment of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg Eppendorf, Martinistr. 52, Hamburg 20246, Germany.ORCID 0000-0003-3457-0936
Moritz F SinnerDepartment of Medicine I, University Hospital Munich, Ludwig Maximilian University of Munich (LMU), Munich, Germany.ORCID 0000-0002-6660-796X
Renate B SchnabelDepartment of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg Eppendorf, Martinistr. 52, Hamburg 20246, Germany.ORCID 0000-0001-7170-9509
Ulrich SchottenAtrial Fibrillation NETwork (AFNET), Mendelstr. 11, 48149 Münster, Germany.ORCID 0000-0003-1532-3315
Laura C SommerfeldUniversity Center of Cardiovascular Science, University Heart and Vascular Center Hamburg, University Medical Center Hamburg Eppendorf, Hamburg, Germany.ORCID 0000-0001-9837-8770
Ursula-Henrike Wienhues-ThelenRoche Diagnostics, Penzberg, Germany.
Antonia ZapfGerman Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Martinistr. 52, Hamburg 20246, Germany.ORCID 0000-0002-8467-0508
Tanja ZellerUniversity Center of Cardiovascular Science, University Heart and Vascular Center Hamburg, University Medical Center Hamburg Eppendorf, Hamburg, Germany.ORCID 0000-0003-3379-2641
Paulus KirchhofDepartment of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg Eppendorf, Martinistr. 52, Hamburg 20246, Germany.ORCID 0000-0002-1881-0197

Funding

Abbott Medical, Medtronic, Boston ScientificAtrial Fibrillation NETwork (AFNET)British Heart Foundation PG/20/22/35093Bundesministerium für Bildung und Forschung (BMBF)Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK)Dutch Heart Foundation CVON2014-09European Heart Rhythm Association (EHRA)European Research Council (ERC) 648131European Union's Horizon 2020 research and innovation programme 847770European Union's Horizon Europe research and innovation programme 101095480German Center for Cardiovascular Research 81Z1710103German Heart Foundation, University of Hamburg and German Federal Ministry of Education and ResearchGerman Ministry of Research and Education 01ZX1408AGerman Research Foundation Ki 509167694Johnson & JohnsonLeducq FoundationSt. Jude Medical-Abbott, Sanofithe German Heart Foundationthe German Ministry of Education and Researchthe German Ministry of Education and Research FKZ 81X2800182
6 · The paper itself

Abstract

BACKGROUND AND

aimsIn patients with atrial fibrillation (AF), recurrent AF and sinus rhythm during follow-up are determined by interactions between cardiovascular disease processes and rhythm control therapy. Predictors of attaining sinus rhythm at follow-up are not well known.

methodsTo quantify the interaction between cardiovascular disease processes and rhythm outcomes, 14 biomarkers reflecting AF-related cardiovascular disease processes in 1586 patients in the EAST-AFNET 4 biomolecule study (71 years old, 45% women) were quantified at baseline. Mixed logistic regression models including clinical features were constructed for each biomarker. Biomarkers were interrogated for interaction with early rhythm control. Outcome was sinus rhythm at 12 months. Results were validated at 24 months and in external datasets.

resultsHigher baseline concentrations of three biomarkers were independently associated with a lower chance of sinus rhythm at 12 months: angiopoietin 2 (ANGPT2) (odds ratio [OR] .76 [95% confidence interval .65-.89], P < .001), bone morphogenetic protein 10 (BMP10) (OR .83 [.71-.97], P = .017), and N-terminal pro-B-type natriuretic peptide (NT-proBNP) (OR .73 [.60-.88], P < .001). Analysis of rhythm at 24 months confirmed the results. Early rhythm control interacted with the predictive potential of NT-proBNP (Pinteraction = .033). The predictive effect of NT-proBNP was reduced in patients randomized to early rhythm control (usual care: OR .64 [.51-.80], P < .001; early rhythm control: OR .90 [.69-1.18], P = .453). External validation confirmed that low concentrations of ANGPT2, BMP10, and NT-proBNP predict sinus rhythm during follow-up.

conclusionsLow concentrations of ANGPT2, BMP10, and NT-proBNP identify patients with AF who are likely to attain sinus rhythm during follow-up. The predictive ability of NT-proBNP is attenuated in patients receiving rhythm control.

Indexed as

Atrial FibrillationBiomarkersNatriuretic Peptide, BrainAgedAngiopoietin-2Bone Morphogenetic ProteinsFemaleGrowth Differentiation Factor 15HumansMaleMiddle AgedPeptide FragmentsRecurrenceAngiopoietin-2BiomarkersBMP10 protein, humanBone Morphogenetic ProteinsGrowth Differentiation Factor 15Natriuretic Peptide, BrainPeptide Fragmentspro-brain natriuretic peptide (1-76)Angiopoietin 2Atrial fibrillationBlood biomarkerBone morphogenetic protein 10Natriuretic peptidesRhythm controlRisk predictionRisk scoreSinus rhythm

Identifiers

PMID39215973
PMCPMC11646612

What Socratic holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.