Outcomes trials
Higher preoperative plasma CETP is one of four protein signals linked to atrial fibrillation after bypass surgery (J Thorac Cardiovasc Surg 2021)
Original title: Preoperative plasma biomarkers associated with atrial fibrillation after coronary artery bypass surgery
A prospective multi-omics study collected preoperative plasma from 170 patients undergoing coronary artery bypass grafting, split into a 90-patient discovery set and an 80-patient validation set, comparing those who developed postoperative atrial fibrillation (POAF) with those who stayed in sinus rhythm. Proteomic and metabolomic profiling identified 29 differential proteins and 61 differential metabolites in the POAF group, with integrated pathway analysis implicating preoperative dysregulation of peroxisome proliferator-activated receptor alpha and glutathione metabolism. Among the differential proteins, lower plasma phospholipid transfer protein and apolipoprotein C3, and higher CETP and glutathione peroxidase 3, were linked to POAF. The authors propose these proteins as candidate predictive biomarkers, describing this as the first multi-omics exploration of POAF mechanism, validated in an independent cohort; CETP is one of four markers rather than the primary focus.
Original abstract
Objectives: Postoperative atrial fibrillation (POAF) is a common complication in coronary artery bypass grafting (CABG) procedures. This prospective study aimed to investigate predisposition of proteins and metabolites correlated to POAF after CABG and related cellular pathways.
Methods: Preoperative plasma samples from patients undergoing CABG procedures were prospectively collected. After CABG, the patients were grouped to POAF or sinus rhythm (N = 170; n = 90 in the discovery set and n = 80 in the validation set). The plasma samples were analyzed using proteomics, metabolomics, and bioinformatics to identify the differential proteins and differential metabolites. The correlation between differential proteins and POAF was also investigated by multivariable regression analysis and receiver operator characteristic analysis.
Results: In the POAF(+) group, 29 differential proteins and 61 differential metabolites were identified compared with the POAF(-) group. The analysis of integrated omics revealed that preoperative alteration of peroxisome proliferators-activated receptor α and glutathione metabolism pathways increased the susceptibility of POAF after CABG. There was a correlation between plasma levels of apolipoprotein-C3, phospholipid transfer protein, glutathione peroxidase 3, cholesteryl ester transfer protein, and POAF.
Conclusions: The present study for first time at multi-omics levels explored the mechanism of POAF and validated the results in a new cohort of patients, suggesting preexisting differential proteins and differential metabolites in the plasma of patients prone to POAF after CABG. Dysregulation of peroxisome proliferators-activated receptor α and glutathione metabolism pathways related to metabolic remodeling and redox imbalance-associated electrical remodeling may play a key role in the pathogenesis of POAF. Lower plasma phospholipid transfer protein, apolipoprotein-C3, higher cholesteryl ester transfer protein and glutathione peroxidase 3 levels are linked with POAF. These proteins/metabolites may be developed as biomarkers to predict POAF.
Summary written by cetpinhibition.org from the published abstract; figures as published. Page updated 18 August 2026. Methods.