Author + information
- Adam Phillip Bress,
- Shitalben Patel,
- Ankit A. Desai,
- Ibrahim Mansour,
- Vicki Groo,
- Jin Han,
- Kristin Progar,
- Ebony Shah,
- Thomas Stamos,
- Rick Kittles and
- Larisa Cavallari
The renin-angiotensin-aldosterone system is central to the pathogenesis of heart failure (HF) and atrial fibrillation (AF). Aldosterone synthase catalyzes the final reaction to generate aldosterone. The aldosterone synthase (CYP11B2) c.-344T>C (rs1799998) variant has been linked to aldosterone synthase activity and presence of AF in HF in Caucasians. We, therefore, evaluated the possible association between the −344T>C SNP and AF in African-Americans (AA) with HF.
We enrolled 199 self-reported AA adults with HF on optimal conventional medical therapies. After obtaining written informed consent, a genetic sample was obtained, and clinical data and echocardiographic measurements of left ventricular (LV) ejection fraction, left atrial size, LV diastolic diameter and severity of mitral regurgitation (MR) were recorded. Multiple logistic regression permitted tests of association between CYP11B2 -344T>C and presence of AF while holding clinical factors and echocardiographic measurements constant.
The mean age of the study population was 55±14 years, 23% were ischemic in etiology, and the mean LV ejection fraction was 29±14%. The CYP11B2 -344 CC genotype was observed in 3.7% of patients, and AF was present in 20% of patients. The prevalence of AF was 71% among patients with the CC genotype and 29% among the CT or TT genotype group (OR 11.3, 95% CI 2.1-60.4, p=0.004). No patient with the CC genotype was on an aldosterone antagonist. After adjustments for age, gender, body size, NYHA class, renal function, systemic hypertension, aldosterone antagonist use, and echocardiographic parameters, the CYP11B2–344 CC genotype was a strong independent predictor of AF (OR 10.1, 95% CI 1.28-79.1, p=0.028).
In this cohort of AAs with HF, the CYP11B2 CC genotype was a significant predictor of AF while holding clinical and echocardiographic predictors of AF constant. Whether strategies, such as additional aldosterone antagonism, ameliorate this risk remains to be determined.
Moderated Poster Contributions
Poster Sessions, Expo North
Sunday, March 10, 2013, 9:45 a.m.-10:30 a.m.
Session Title: Atrial Fibrillation Mechanisms and Stroke Prevention
Abstract Category: 4. Arrhythmias: AF/SVT
Presentation Number: 1191M-51
- 2013 American College of Cardiology Foundation