Background::The CHA 2DS 2–VASc score was initially applied to stratify stroke risk in patients with atrial fibrillation (AF) and was found to be effective in predicting all-cause mortality outcomes. To date, it is still unclear whether circulating long non-coding RNAs (lncRNAs) as emerging biomarkers, can improve the predictive power of the CHA 2DS 2–VASc score in stroke and all-cause mortality. Methods::Candidate lncRNAs were screened by searching the literature and analyzing previous RNA sequencing results. After preliminary verification in 29 patients with AF, the final selected lncRNAs were evaluated by Cox proportional hazards regression in 192 patients to determine whether their relative expression levels were associated with stroke and all-cause mortality. The c-statistic, net reclassification improvement (NRI), and integrated discrimination improvement of the patients were calculated to evaluate the discrimination and reclassification power for stroke and all-cause mortality when adding lncRNA expression levels to the CHA 2DS 2–VASc score model. Results::Five plasma lncRNAs associated with stroke and all-cause mortality in AF patients were selected in our screening process. Patients with elevated H19 levels were found to have a higher risk of stroke (hazard ratio [HR] 3.264, 95% confidence interval [CI]: 1.364–7.813, P = 0.008). Adding the H19 expression level to the CHA 2DS 2–VASc score significantly improved the discrimination and reclassification power of the CHA 2DS 2–VASc score for stroke in AF patients. In addition, the H19 level showed a marginally significant association with all-cause mortality (HR 2.263, 95% CI: 0.889–5.760, P = 0.087), although it appeared to have no significant improvement for the CHA 2DS 2–VASc model for predicting all-cause mortality. Conclusions::Plasma expression of H19 was associated with stroke risk in AF patients and improved the discriminatory power of the CHA 2DS 2–VASc score. Therefore, lncRNA H19 served as an emerging non-invasive biomarker for stroke risk prediction in patients with AF.

Atrial fibrillation;Long non-coding RNA;H19;Prognosis

Zhang Yuanbo;Wang Duan;Wu Na;Chen Xinghua;Yuan Zhiquan;Jia Xiaoyue;Li Chengying;Hu Qin;Chen Yanxiu;Zhang Zhihui;Zhong Li;Li Yafei

Department of Epidemiology, College of Preventive Medicine, Army Medical University (Third Military Medical University), Chongqing 400038, China;Department of Cardiology, Third Affiliated Hospital of Chongqing Medical University, Chongqing 401120, China;Department of Cardiology, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing 400038, China

中华医学杂志（英文版）

[1]Zhang Yuanbo;Wang Duan;Wu Na;Chen Xinghua;Yuan Zhiquan;Jia Xiaoyue;Li Chengying;Hu Qin;Chen Yanxiu;Zhang Zhihui;Zhong Li;Li Yafei-.Role of circulating long non-coding RNA for the improvement of the predictive ability of the CHA 2DS 2–VASc score in patients with atrial fibrillation )[J].中华医学杂志（英文版）,2022(12):1451-1458

fibrillation

Role,circulating,long,coding,improvement,predictive,ability,CHA ,2DS ,VASc,score,patients,atrial,Background,was,initially,applied,stratify,stroke,risk,AF,found,be,effective,predicting,cause,mortality,outcomes,To,still,unclear,whether,lncRNAs,emerging,biomarkers,power,Methods,Candidate,were,screened,by,searching,literature,analyzing,previous,sequencing,results,After,preliminary,verification,final,selected,evaluated,Cox,proportional,hazards,regression,determine,their,relative,expression,levels,associated,statistic,net,reclassification,NRI,integrated,discrimination,calculated,when,adding,model,Results,Five,plasma,our,screening,process,Patients,elevated,H19,have,higher,ratio,confidence,interval,Adding,significantly,improved,In,addition,showed,marginally,association,although,appeared,Conclusions,Plasma,discriminatory,Therefore,served,invasive,prediction,Atrial,Long,Prognosis

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