The Role of Inflammation and Coagulation Cascade in the Pathogenesis of Atrial Fibrillation

Introduction: Atrial fibrillation (AF) is associated with prothrombotic or hypercoagulable states, various inflammation markers such as interleukin-6 (IL-6) and hsC-reactive protein (hsCRP) have also been associated with AF. The aim of this study is to investigate the relationship between inflammation markers and the prothrombotic state in the setting of AF and the impact on outcome in patients with AF. Methods: We observed 141 patients with non-valvular AF. As a control group patients similar in gender and age without AF were examined. Clinical, instrumental and laboratory tests were performed on the observed patients. The markers of the coagulation cascade (TF and F) and of inflammatory markers (hsCRP and IL-6) were studied additionally by ELISA on the analyzer "Stat Fax 303 Plus". Studies were conducted using SPSS 13.0 and EXCEL-2013. Results: The obtained results showed that compared to the control group, AF patients had significantly higher levels of IL-6 (p = 0.043), hsCRP (p = 0.002), TF (p = 0.026), and F (p = 0.025). Moreover, levels of hsCRP were higher among AF patients at "high" risk of stroke by CHA2DS2-VASc Score (p = 0.003). Besides, the levels of hsCRP and IL-6 were markedly elevated in patients with dilated left atrium (p = 0.001), poorly functioning left atrial appendage (p = 0.023) and longer duration of AF (p = 0.002). Conclusion: We have demonstrated that the increased plasma levels of IL-6 and hsCRP are related to indices of the coagulation cascade and contribute to structural atrial remodeling in patients with AF.