Serum Vasoactive Intestinal Peptide as a Novel Biomarker for Low‐Voltage Areas in Patients With Atrial Fibrillation

Figures

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  Figure 1. Differences in VIP concentration based on LVA type and site. Comparison of serum VIP levels between patients with and without LVAs along with a representative figure. A, Patients with LVAs exhibit significantly higher VIP levels than those without LVAs. B, Representative EAM images of the patients with low serum VIP levels without LVAs. C, Representative EAM images from patients with LVAs and high VIP levels. D, The segmentation of the left atrium into 6 regions: Anterior, Posterior, Roof, Bottom, Lateral, and Septal. E, The frequency of LVAs in each left atrial segment, with the highest occurrence in the anterior and septal regions. F, Serum VIP levels in the segments with the highest LVA frequency showing no significant variation. AP indicates anterior–posterior; EAM, electroanatomical mapping; LIPV, left inferior pulmonary vein; LSPV, left superior pulmonary vein; MV, mitral valve; PA, posterior–anterior; RIPV, right inferior pulmonary vein; RSPV, right superior pulmonary vein; LVA, low‐voltage area; VIP, vasoactive intestinal peptide.

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  Figure 2. ROC curves for the prediction of LVA. A, ROC curve for the VIP level. B, ROC curve with combined score (VIP ≥288 pg/mL + female sex), showing a higher AUC than (C). C, ROC curve for ZAQ score (age ≥65 years, female sex, LAVI ≥57 mL/m2). D, ROC curve for the combined VIP+ZAQ score. E, Comparison of ROC curves for ZAQ scores and combined VIP+ZAQ scores, illustrating improved predictive ability. AUC indicates area under the curve; LAVI, left atrial volume index; LVA, low‐voltage area; ROC, receiver operating characteristic; VIP, vasoactive intestinal peptide; and ZAQ, Zentralklinik Bad Berka and University of L'Aquila.

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  Figure 3. Comparison of serum VIP levels across 4 groups stratified by LVA and HF status, and by LVA and LAE status. A, Serum VIP levels among patients stratified by the presence of LVA and HF status (without HF and with HF). B, Serum VIP levels among patients stratified by the presence of LVA and LAE status (without LAE and with LAE). In both analyses, significant differences in serum VIP levels were observed among the 4 groups, with higher levels seen in groups with LVAs. HF indicates heart failure; LAE, left atrial enlargement; LVA, low‐voltage area; and VIP, vasoactive intestinal peptide.