Chitinase-3-like protein-1 (YKL-40) before and after therapy in supraventricular arrhythmias.

BACKGROUND: The inflammatory glycoprotein chitinase-3-like protein 1 or YKL-40 has emerged as a potential biomarker of cardiovascular diseases, including atrial fibrillation (AFib). We sought to assess YKL-40 in a wide spectrum of supraventricular arrhythmias besides AFib in comparison with other inflammatory markers. METHODS: We determined serum levels of YKL-40, C-reactive protein (CRP) and IL-6 in 70 patients with AFib, atrial flutter, atrioventricular node reentry tachycardia or other supraventricular tachycardias before, immediately after therapy and 1 week after therapy; 20 healthy patients served as controls. Patients were subsequently followed for 6 months for arrhythmia recurrence. RESULTS: Baseline YKL-40 was significantly elevated in AFib patients [99.5 (65.5,194) ng/ml versus 47.2 (38.9,51.6) ng/ml in controls, P < 0.001], but not in patients with other arrhythmias. YKL-40 levels correlated positively with left atrial volume index (Spearman's rho = 0.853, P < 0.001). Its levels dropped significantly 1 week posttreatment only in AFib (P = 0.009 versus baseline); CRP and IL-6 remained practically stable throughout the study. Arrhythmia recurrence at 6 months occurred in 13 patients (19%), including 11 with AFib and 2 with atrial flutter. Baseline YKL-40 was independently associated with AFib recurrence (adjusted odds ratio = 1.02, 95% confidence interval = 1.00-1.04, P = 0.016). Neither CRP nor IL-6 was associated with AFib recurrence. CONCLUSION: Serum YKL-40 was elevated only in AFib and not in other supraventricular arrhythmias. In AFib, YKL-40 levels were responsive to therapy and predicted long-term recurrence.

Congenitally corrected transposition of the great arteries in a seventy-year-old woman.

Corrected transposition of the great arteries is a rare condition, and few patients with this abnormality survive past 50 years of age because of associated defects, or the subsequent development of atrioventricular valvular insufficiency or heart block or both. The case of our patient is of interest not only because she reached old age, but also because she lived a normal life, presenting with minor cardiac impairment and palpitations at the age of 70 years.