EVALUATION OF FERRITIN LEVELS AND OTHER CIRCULATING PARAMETERS AS PREDICTIVE BIOMARKERS OF POSTOPERATIVE ATRIAL FIBRILLATION RISK

BACKGROUND-AIM Postoperative atrial fibrillation (POAF) represents a critical issue in the cardiovascular area as well as the most common arrhythmia post cardiothoracic surgery. POAF, thus, is associated with diverse severe complications, including potentially fatal conditions. The risk of developing stroke is particularly frequent in post-cardiothoracic surgery AF patients. Little is known about the pathophysiological mechanisms that lead to this fibrillation and there are currently no useful markers to predict it. Yet, it is known that ferritin, a protein that into the serum act as an iron carrier, it’s correlated with an increased risk for atrial fibrillation. METHODS Based on this evidence, here, we evaluated, through a retrospective observational study, the validity of ferritin and other haematological parameters as POAF risk biomarkers in patients undergoing cardiac surgery. The cohort consists of 105 patients (mean age = 70.1 ± 7.1 years; 70 men and 35 females) with an history of cardiothoracic surgery. Haematological, electrocardiographic, and echocardiographic parameters were evaluated. RESULTS The data obtained evidenced that POAF patients showed significantly higher concentrations, absolute values, and percentages, of ferritin, RDW, and PLTs, respectively. However, after adjustment for other risk POAF variables, the ferritin resulted to be the independent factor associated with the onset POAF risk. Such result led us to identify the ferritin cut-off value, which, when equal to or greater than the value of 148.5 ng/mL, identifies the subjects with highest risk of developing POAF. These findings demonstrated, for the first time, the importance of detecting serum ferritin values, and if ≥148.5 ng/mL, the individuals subject to cardiothoracic surgery, this suggests a high probability of developing POAF after the surgery treatment in conventional extracorporeal circulation (CECC). CONCLUSIONS Thus, serum ferritin, RDW, and PTLs represent predictive biomarkers of POAF after cardiothoracic surgery in CECC; particularly, serum ferritin combined with anormal PW indices and structural heart disease variables can represent an excellent tool for predicting not only POAF, but also the eventual stroke onset.