Integrated Diagnostics for Atrial Fibrillation Recurrence: Exploratory Results from the PLACEBO Trial
<b>Background</b>: Atrial fibrillation is a prevalent arrhythmia with significant morbidity and recurrence challenges. Paroxysmal atrial fibrillation (PAF) is characterized by episodic occurrences and unpredictable recurrences; therefore, it demands innovative diagnostic approaches to pr...
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MDPI AG
2025-04-01
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| author | Aristi Boulmpou Theodoros Moysiadis Georgios Zormpas Eleftherios Teperikidis Konstantina Tsioni Maria Toumpourleka Maria Zidrou Georgios Giannakoulas Vassilios Vassilikos Christodoulos Papadopoulos |
| author_facet | Aristi Boulmpou Theodoros Moysiadis Georgios Zormpas Eleftherios Teperikidis Konstantina Tsioni Maria Toumpourleka Maria Zidrou Georgios Giannakoulas Vassilios Vassilikos Christodoulos Papadopoulos |
| author_sort | Aristi Boulmpou |
| collection | DOAJ |
| description | <b>Background</b>: Atrial fibrillation is a prevalent arrhythmia with significant morbidity and recurrence challenges. Paroxysmal atrial fibrillation (PAF) is characterized by episodic occurrences and unpredictable recurrences; therefore, it demands innovative diagnostic approaches to predict relapses and guide management. <b>Objectives</b>: This pilot, exploratory study evaluates the feasibility and prognostic value of integrating cardiopulmonary exercise testing (CPET), echocardiographic indices, and plasma biomarkers for predicting PAF recurrence. <b>Methods</b>: The PLACEBO trial is a single-center, prospective observational study of 73 adults with PAF in sinus rhythm at baseline. Comprehensive assessments included CPET, transthoracic echocardiography, 24 h electrocardiographic Holter monitoring with heart rate variability (HRV) metrics, and plasma biomarkers, such as galectin-3 (GAL3). Recurrence was defined as any documented AF episode lasting ≥30 s within 12 months of follow-up. <b>Results</b>: Binary logistic regression revealed that the standard deviation of RR intervals (SDRR) and GAL3 were significant predictors of recurrence. Particularly, higher SDRR [odds ratio (OR): 1.061, <i>p</i> = 0.021] and GAL3 > 10.95 ng/mL (OR: 5.206, <i>p</i> = 0.006) were associated with recurrence. Moreover, lower right ventricular fractional area change (RV FAC) exhibited a marginally significant association with recurrence (OR: 0.927, <i>p</i> = 0.062). CPET parameters demonstrated limited prognostic value in this cohort. <b>Conclusion</b>: This pilot study demonstrates that integrating novel echocardiographic indices, biomarkers, and HRV metrics is feasible and may provide valuable prognostic insights for PAF recurrence. Larger multicenter studies are needed to validate these findings and optimize personalized risk stratification strategies. |
| format | Article |
| id | doaj-art-a5ae4f2fb8cb4f8bbdb15d1876248773 |
| institution | OA Journals |
| issn | 2075-4418 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | MDPI AG |
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| series | Diagnostics |
| spelling | doaj-art-a5ae4f2fb8cb4f8bbdb15d18762487732025-08-20T02:24:45ZengMDPI AGDiagnostics2075-44182025-04-01159110510.3390/diagnostics15091105Integrated Diagnostics for Atrial Fibrillation Recurrence: Exploratory Results from the PLACEBO TrialAristi Boulmpou0Theodoros Moysiadis1Georgios Zormpas2Eleftherios Teperikidis3Konstantina Tsioni4Maria Toumpourleka5Maria Zidrou6Georgios Giannakoulas7Vassilios Vassilikos8Christodoulos Papadopoulos9Third Department of Cardiology, Ippokratio General Hospital, Aristotle University of Thessaloniki, 54642 Thessaloniki, GreeceDepartment of Computer Science, School of Sciences and Engineering, University of Nicosia, 2417 Nicosia, CyprusSecond Department of Cardiology, Ippokratio General Hospital, Aristotle University of Thessaloniki, 54642 Thessaloniki, GreeceThird Department of Cardiology, Ippokratio General Hospital, Aristotle University of Thessaloniki, 54642 Thessaloniki, GreeceBiopathology Laboratory, Ippokratio General Hospital, 54642 Thessaloniki, GreeceThird Department of Cardiology, Ippokratio General Hospital, Aristotle University of Thessaloniki, 54642 Thessaloniki, GreeceThird Department of Cardiology, Ippokratio General Hospital, Aristotle University of Thessaloniki, 54642 Thessaloniki, GreeceFirst Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, GreeceThird Department of Cardiology, Ippokratio General Hospital, Aristotle University of Thessaloniki, 54642 Thessaloniki, GreeceThird Department of Cardiology, Ippokratio General Hospital, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece<b>Background</b>: Atrial fibrillation is a prevalent arrhythmia with significant morbidity and recurrence challenges. Paroxysmal atrial fibrillation (PAF) is characterized by episodic occurrences and unpredictable recurrences; therefore, it demands innovative diagnostic approaches to predict relapses and guide management. <b>Objectives</b>: This pilot, exploratory study evaluates the feasibility and prognostic value of integrating cardiopulmonary exercise testing (CPET), echocardiographic indices, and plasma biomarkers for predicting PAF recurrence. <b>Methods</b>: The PLACEBO trial is a single-center, prospective observational study of 73 adults with PAF in sinus rhythm at baseline. Comprehensive assessments included CPET, transthoracic echocardiography, 24 h electrocardiographic Holter monitoring with heart rate variability (HRV) metrics, and plasma biomarkers, such as galectin-3 (GAL3). Recurrence was defined as any documented AF episode lasting ≥30 s within 12 months of follow-up. <b>Results</b>: Binary logistic regression revealed that the standard deviation of RR intervals (SDRR) and GAL3 were significant predictors of recurrence. Particularly, higher SDRR [odds ratio (OR): 1.061, <i>p</i> = 0.021] and GAL3 > 10.95 ng/mL (OR: 5.206, <i>p</i> = 0.006) were associated with recurrence. Moreover, lower right ventricular fractional area change (RV FAC) exhibited a marginally significant association with recurrence (OR: 0.927, <i>p</i> = 0.062). CPET parameters demonstrated limited prognostic value in this cohort. <b>Conclusion</b>: This pilot study demonstrates that integrating novel echocardiographic indices, biomarkers, and HRV metrics is feasible and may provide valuable prognostic insights for PAF recurrence. Larger multicenter studies are needed to validate these findings and optimize personalized risk stratification strategies.https://www.mdpi.com/2075-4418/15/9/1105paroxysmal atrial fibrillationCPETechocardiographybiomarkersrisk stratification |
| spellingShingle | Aristi Boulmpou Theodoros Moysiadis Georgios Zormpas Eleftherios Teperikidis Konstantina Tsioni Maria Toumpourleka Maria Zidrou Georgios Giannakoulas Vassilios Vassilikos Christodoulos Papadopoulos Integrated Diagnostics for Atrial Fibrillation Recurrence: Exploratory Results from the PLACEBO Trial Diagnostics paroxysmal atrial fibrillation CPET echocardiography biomarkers risk stratification |
| title | Integrated Diagnostics for Atrial Fibrillation Recurrence: Exploratory Results from the PLACEBO Trial |
| title_full | Integrated Diagnostics for Atrial Fibrillation Recurrence: Exploratory Results from the PLACEBO Trial |
| title_fullStr | Integrated Diagnostics for Atrial Fibrillation Recurrence: Exploratory Results from the PLACEBO Trial |
| title_full_unstemmed | Integrated Diagnostics for Atrial Fibrillation Recurrence: Exploratory Results from the PLACEBO Trial |
| title_short | Integrated Diagnostics for Atrial Fibrillation Recurrence: Exploratory Results from the PLACEBO Trial |
| title_sort | integrated diagnostics for atrial fibrillation recurrence exploratory results from the placebo trial |
| topic | paroxysmal atrial fibrillation CPET echocardiography biomarkers risk stratification |
| url | https://www.mdpi.com/2075-4418/15/9/1105 |
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