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Background <p>Post-operative atrial fibrillation (POAF) prolongs recovery after cardiac surgery. We evaluated whether two myocardial-remodelling biomarkers—procollagen type I C-terminal propeptide (PICP) and procollagen type III N-terminal propeptide (PIIINP)—predict POAF in elderly patients.</p> Methods <p>In a prospective cohort (August 2024 – January 2025), 113 patients ≥ 65 years undergoing coronary artery bypass grafting, valve, or combined surgery were enrolled. Pre-operative serum PICP and PIIINP were quantified. POAF episodes were continuously monitored for five days. Independent predictors were identified with multivariable logistic regression, and discriminative performance was assessed using receiver-operating-characteristic (ROC) curves with 2,000-bootstrap internal validation.</p> Results <p>POAF developed in 40 patients (35.4%), peaking on post-operative day 2. Compared with non-POAF patients, the POAF group had larger left atria (45.3 ± 4.8 vs. 40.7 ± 5.1&#xa0;mm; <i>p</i> &lt; 0.001) and higher PICP (128.4 ± 27.1 vs. 103.2 ± 24.6&#xa0;µg/L) and PIIINP (13.3 ± 3.9 vs. 9.8 ± 2.8&#xa0;µg/L) concentrations (both <i>p</i> &lt; 0.001). Age, left-atrial dimension, PICP, and PIIINP remained independent predictors (all <i>p</i> &lt; 0.05). A model combining both biomarkers achieved an area under the ROC curve (AUC) of 0.86, outperforming PICP (0.80) or PIIINP (0.78) alone. Bootstrap validation yielded a mean AUC of 0.85 (95% CI 0.79–0.90), indicating good internal robustness.</p> Conclusions <p>Elevated pre-operative PICP and PIIINP independently predict POAF in elderly cardiac-surgery patients, and their combination enhances risk stratification beyond clinical factors. Incorporating these biomarkers could guide targeted prophylaxis and improve peri-operative management; prospective multicentre validation is warranted.</p>

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Diagnostic value of pre-operative serum procollagen type I C-terminal propeptide and procollagen type III N-terminal propeptide levels for post-operative atrial fibrillation in elderly cardiac-surgery patients

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年3月11日

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  • Weibo He,
  • Dongmei Sun,
  • Xinming Bai,
  • Tao Zhong,
  • Yuan Wu,
  • Yuanping Feng

摘要

Background

Post-operative atrial fibrillation (POAF) prolongs recovery after cardiac surgery. We evaluated whether two myocardial-remodelling biomarkers—procollagen type I C-terminal propeptide (PICP) and procollagen type III N-terminal propeptide (PIIINP)—predict POAF in elderly patients.

Methods

In a prospective cohort (August 2024 – January 2025), 113 patients ≥ 65 years undergoing coronary artery bypass grafting, valve, or combined surgery were enrolled. Pre-operative serum PICP and PIIINP were quantified. POAF episodes were continuously monitored for five days. Independent predictors were identified with multivariable logistic regression, and discriminative performance was assessed using receiver-operating-characteristic (ROC) curves with 2,000-bootstrap internal validation.

Results

POAF developed in 40 patients (35.4%), peaking on post-operative day 2. Compared with non-POAF patients, the POAF group had larger left atria (45.3 ± 4.8 vs. 40.7 ± 5.1 mm; p < 0.001) and higher PICP (128.4 ± 27.1 vs. 103.2 ± 24.6 µg/L) and PIIINP (13.3 ± 3.9 vs. 9.8 ± 2.8 µg/L) concentrations (both p < 0.001). Age, left-atrial dimension, PICP, and PIIINP remained independent predictors (all p < 0.05). A model combining both biomarkers achieved an area under the ROC curve (AUC) of 0.86, outperforming PICP (0.80) or PIIINP (0.78) alone. Bootstrap validation yielded a mean AUC of 0.85 (95% CI 0.79–0.90), indicating good internal robustness.

Conclusions

Elevated pre-operative PICP and PIIINP independently predict POAF in elderly cardiac-surgery patients, and their combination enhances risk stratification beyond clinical factors. Incorporating these biomarkers could guide targeted prophylaxis and improve peri-operative management; prospective multicentre validation is warranted.