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Chen P, Zhang J, Du J, Shi D, Zhang H. Predictive value of soluble suppression of tumorigenicity 2 in atrial fibrillation: a systematic review and meta-analysis. Front Cardiovasc Med 2024; 10:1308166. [PMID: 38274310 PMCID: PMC10808625 DOI: 10.3389/fcvm.2023.1308166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 12/22/2023] [Indexed: 01/27/2024] Open
Abstract
Purpose Atrial fibrosis is the main pathological basis for the pathogenesis and progression of atrial fibrillation (AF). Soluble suppression of tumorigenicity 2 (sST2) is involved in fibrosis. Recent studies have explored its predictive value in AF outcomes. We performed this study to assess whether sST2 is an independent biomarker of AF outcomes and explore the potential mechanism. Methods PubMed, Web of Science, EMBASE, and Cochrane Library databases were searched systematically from inception through July 1, 2023, to identify relevant studies. Outcomes of interest included occurrence, recurrence, and major adverse cardiac events (MACEs) of AF. This meta-analysis was reported following the criteria outlined in PRISMA 2020, and the protocol was registered in PROSPERO (number: CRD42023459789). All statistical analyses were performed using the STATA version 16. Result Twenty four studies with 14,755 patients were included in the meta-analysis. The meta-analyses found that sST2 was significantly associated with the risk of occurrence [HR:1.04, 95% CI: 1.02-1.07, P < 0.01; I2 = 67.8%], recurrence [HR:1.09, 95% CI: 1.02-1.16, P < 0.01; I2 = 89.5%], and MACEs (HR:1.60, 95% CI: 1.13-2.27, P < 0.01; I2 = 82.0%) of AF. Furthermore, patients with AF showed higher sST2 than controls without AF (SMD: 0.41, 95% CI: 0.27-0.54, P < 0.01; I2 = 0%), and AF patients with recurrence after catheter ablation (CA) showed significantly higher sST2 than those without recurrence (SMD: 0.81, 95% CI: 0.33-1.28, P < 0.01; I2 = 83.9%). Sensitivity analyses showed that the outcomes were stable. Conclusions Higher sST2 was association with an increased risk of occurrence, recurrence, and MACEs of AF. Assessing sST2 can be used as a potential screening method to predict AF outcomes. Systematic Review Registration PROSPERO (CRD42023459789).
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Affiliation(s)
- Pengfei Chen
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Cardiovascular Diseases Center, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Jie Zhang
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Jianpeng Du
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Cardiovascular Diseases Center, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Dazhuo Shi
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Cardiovascular Diseases Center, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - He Zhang
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Cardiovascular Diseases Center, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
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Yi C, Liu J, Deng W, Luo C, Qi J, Chen M, Xu H. Old age promotes retinal fibrosis in choroidal neovascularization through circulating fibrocytes and profibrotic macrophages. J Neuroinflammation 2023; 20:45. [PMID: 36823538 PMCID: PMC9947907 DOI: 10.1186/s12974-023-02731-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 02/13/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND Retinal fibrosis affects 40-70% of neovascular age-related macular degeneration patients. This study investigated the effect of ageing on subretinal fibrosis secondary to choroidal neovascularization and the mechanism of action. METHODS Subretinal fibrosis was induced in young (2.5-month) and aged (15-16-month) C57BL/6J mice using the two-stage laser protocol. Five and 30 days later, eyes were collected and stained for CD45 and collagen-1 and observed by confocal microscopy. Fibrocytes (CD45+collagen-1+) were detected in the bone marrow (BM), blood and fibrotic lesions by flow cytometry and confocal microscopy, respectively. BM-derived macrophages (BMDMs) were cultured from young and aged mice with or without TGF-β1 (10 ng/mL) treatment. The expression of mesenchymal marker αSMA (Acta2), fibronectin (Fn1) and collagen-1 (Col1a1) was examined by qPCR and immunocytochemistry, whereas cytokine/chemokine production was measured using the Luminex multiplex cytokine assay. BM were transplanted from 22-month (Ly5.2) aged mice into 2.5-month (Ly5.1) young mice and vice versa. Six weeks later, subretinal fibrosis was induced in recipient mice and eyes were collected for evaluation of fibrotic lesion size. RESULTS Under normal conditions, the number of circulating fibrocytes (CD45+collagen-1+) and the expression levels of Tgfb1, Col1a1, Acta2 and Fn1 in BMDMs were significantly higher in aged mice compared to young mice. Induction of subretinal fibrosis significantly increased the number of circulating fibrocytes, enhanced the expression of Col1a1, Acta2 and Fn1 and the production of soluble urokinase plasminogen activator surface receptor (suPAR) but decreased the production of CXCL10 in BMDMs. BMDMs from aged subretinal fibrosis mice produced significantly higher levels of VEGF, angiopoietin-2 and osteopontin than cells from young subretinal fibrosis mice. The subretinal fibrotic lesion in 15-16-month aged mice was 62% larger than that in 2.5-month young mice. The lesion in aged mice contained a significantly higher number of fibrocytes compared to that in young mice. The number of circulating fibrocytes positively correlated with the size of subretinal fibrotic lesion. Transplantation of BM from aged mice significantly increased subretinal fibrosis in young mice. CONCLUSIONS A retina-BM-blood-retina pathway of fibrocyte/macrophage recruitment exists during retinal injury. Ageing promotes subretinal fibrosis through higher numbers of circulating fibrocytes and profibrotic potential of BM-derived macrophages.
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Affiliation(s)
- Caijiao Yi
- Aier School of Ophthalmology, Central South University, Changsha, 410000 China
- Aier Institute of Optometry and Vision Science, Changsha, 410000 China
- Department of Ophthalmology, The Second Xiangya Hospital, Central South University, Changsha, 410011 China
- Hunan Province Optometry Engineering and Technology Research Center, Changsha, 410009 China
- Hunan Province International Cooperation Base for Optometry Science and Technology, Changsha, 410009 China
| | - Jian Liu
- Aier Institute of Optometry and Vision Science, Changsha, 410000 China
- Hunan Province Optometry Engineering and Technology Research Center, Changsha, 410009 China
- Hunan Province International Cooperation Base for Optometry Science and Technology, Changsha, 410009 China
| | - Wen Deng
- Aier School of Ophthalmology, Central South University, Changsha, 410000 China
- Aier Institute of Optometry and Vision Science, Changsha, 410000 China
| | - Chang Luo
- Aier School of Ophthalmology, Central South University, Changsha, 410000 China
| | - Jinyan Qi
- Aier School of Ophthalmology, Central South University, Changsha, 410000 China
- Aier Institute of Optometry and Vision Science, Changsha, 410000 China
| | - Mei Chen
- The Wellcome-Wolfson Institute for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, 97 Lisburn Road, Belfast, BT9 7BL UK
| | - Heping Xu
- Aier School of Ophthalmology, Central South University, Changsha, 410000 China
- Aier Institute of Optometry and Vision Science, Changsha, 410000 China
- Hunan Province Optometry Engineering and Technology Research Center, Changsha, 410009 China
- Hunan Province International Cooperation Base for Optometry Science and Technology, Changsha, 410009 China
- The Wellcome-Wolfson Institute for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, 97 Lisburn Road, Belfast, BT9 7BL UK
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Dean LS, Chow DC, Ndhlovu LC, Boisvert WA, Chang SP, Shikuma CM, Park J. Characterization of Circulating Fibrocytes in People Living with HIV on Stable Antiretroviral Therapy. Immunohorizons 2022; 6:760-767. [PMID: 36445359 PMCID: PMC10402248 DOI: 10.4049/immunohorizons.2200085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 11/02/2022] [Indexed: 01/04/2023] Open
Abstract
Highly effective combination antiretroviral therapy has reduced HIV infection to a manageable chronic disease, shifting the clinical landscape toward management of noninfectious comorbidities in people living with HIV (PLWH). These comorbidities are diverse, generally associated with accelerated aging, and present within multiple organ systems. Mechanistically, immune dysregulation and chronic inflammation, both of which persist in PLWH with well-controlled virally suppressive HIV infection, are suggested to create and exacerbate noninfectious comorbidity development. Persistent inflammation often leads to fibrosis, which is the common end point pathologic feature associated with most comorbidities. Fibrocytes are bone marrow-derived fibroblast-like cells, which emerged as key effector cells in tissue repair and pathologic fibrotic diseases. Despite their relevance to fibrosis, the circulating fibrocyte concentration in PLWH remains poorly characterized, and an understanding of their functional role in chronic HIV is limited. In this study, utilizing PBMCs from a cross-sectional adult HIV cohort study with matched uninfected controls (HIV-), we aimed to identify and compare circulating fibrocytes in blood. Both the percentage and number of fibrocytes and α-smooth muscle actin+ fibrocytes in circulation did not differ between the HIV+ and HIV- groups. However, circulating fibrocyte levels were significantly associated with increasing age in both the HIV+ and HIV- groups (the percentage and number; r = 0.575, p ≤ 0.0001 and r = 0.558, p ≤ 0.0001, respectively). Our study demonstrates that circulating fibrocyte levels and their fibroblast-like phenotype defined as collagen I and α-smooth muscle actin+ expression are comparable between, and strongly associated with, age irrespective of HIV status.
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Affiliation(s)
- Logan S. Dean
- Department of Tropical Medicine, Medical Microbiology, and Pharmacology, University of Hawaii at Manoa, Honolulu, HI
- Hawaii Center for AIDS, John A. Burns School Medicine, University of Hawaii at Manoa, Honolulu, HI
| | - Dominic C. Chow
- Department of Tropical Medicine, Medical Microbiology, and Pharmacology, University of Hawaii at Manoa, Honolulu, HI
- Hawaii Center for AIDS, John A. Burns School Medicine, University of Hawaii at Manoa, Honolulu, HI
| | - Lishomwa C. Ndhlovu
- Department of Tropical Medicine, Medical Microbiology, and Pharmacology, University of Hawaii at Manoa, Honolulu, HI
| | - William A. Boisvert
- Center for Cardiovascular Research, University of Hawaii at Manoa, Honolulu, HI
| | - Sandra P. Chang
- Department of Tropical Medicine, Medical Microbiology, and Pharmacology, University of Hawaii at Manoa, Honolulu, HI
| | - Cecilia M. Shikuma
- Department of Tropical Medicine, Medical Microbiology, and Pharmacology, University of Hawaii at Manoa, Honolulu, HI
- Hawaii Center for AIDS, John A. Burns School Medicine, University of Hawaii at Manoa, Honolulu, HI
| | - Juwon Park
- Department of Tropical Medicine, Medical Microbiology, and Pharmacology, University of Hawaii at Manoa, Honolulu, HI
- Hawaii Center for AIDS, John A. Burns School Medicine, University of Hawaii at Manoa, Honolulu, HI
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Yang L, Chen Y, Huang W. Hub Genes Identification, Small Molecule Compounds Prediction for Atrial Fibrillation and Diagnostic Model Construction Based on XGBoost Algorithm. Front Cardiovasc Med 2022; 9:920399. [PMID: 35911532 PMCID: PMC9329605 DOI: 10.3389/fcvm.2022.920399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 06/21/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundAtrial fibrillation (AF) is the most common sustained cardiac arrhythmia and engenders significant global health care burden. The underlying mechanisms of AF is remained to be revealed and current treatment options for AF have limitations. Besides, a detection system can help identify those at risk of developing AF and will enable personalized management.Materials and MethodsIn this study, we utilized the robust rank aggregation method to integrate six AF microarray datasets from the Gene Expression Omnibus database, and identified a set of differentially expressed genes between patients with AF and controls. Potential compounds were identified by mining the Connectivity Map database. Functional modules and closely-interacted clusters were identified using weighted gene co-expression network analysis and protein–protein interaction network, respectively. The overlapped hub genes were further filtered. Subsequent analyses were performed to analyze the function, biological features, and regulatory networks. Moreover, a reliable Machine Learning-based diagnostic model was constructed and visualized to clarify the diagnostic features of these genes.ResultsA total of 156 upregulated and 34 downregulated genes were identified, some of which had not been previously investigated. We showed that mitogen-activated protein kinase and epidermal growth factor receptor inhibitors were likely to mitigate AF based on Connectivity Map analysis. Four genes, including CXCL12, LTBP1, LOXL1, and IGFBP3, were identified as hub genes. CXCL12 was shown to play an important role in regulation of local inflammatory response and immune cell infiltration. Regulation of CXCL12 expression in AF was analyzed by constructing a transcription factor-miRNA-mRNA network. The Machine Learning-based diagnostic model generated in this study showed good efficacy and reliability.ConclusionKey genes involving in the pathogenesis of AF and potential therapeutic compounds for AF were identified. The biological features of CXCL12 in AF were investigated using integrative bioinformatics tools. The results suggested that CXCL12 might be a biomarker that could be used for distinguishing subsets of AF, and indicated that CXCL12 might be an important intermediate in the development of AF. A reliable Machine Learning-based diagnostic model was constructed. Our work improved understanding of the mechanisms of AF predisposition and progression, and identified potential therapeutic avenues for treatment of AF.
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Kanda T, Masuda M, Asai M, Iida O, Okamoto S, Ishihara T, Nanto K, Tsujimura T, Matsuda Y, Hata Y, Uematsu H, Toyoshima T, Higashino N, Mano T. Impact of left atrial low-voltage areas during initial ablation procedures on very late recurrence of atrial fibrillation. J Cardiovasc Electrophysiol 2022; 33:1697-1704. [PMID: 35748348 DOI: 10.1111/jce.15607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 06/01/2022] [Accepted: 06/20/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Very late recurrence of atrial fibrillation (VLRAF) occurring >1 year after catheter ablation may influence long-term follow-up strategies, including oral anticoagulant therapy. However, little is known about the predictors of this condition. Given that the prevalence of left atrial low-voltage areas (LVAs) is strongly associated with the recurrence of atrial tachyarrhythmias following catheter ablation, we hypothesized that VLRAF might occur more frequently in patients with LVAs at the time of initial ablation. The purpose of this study was to investigate the impact of LVAs on VLRAF. METHODS This study included 1001 consecutive patients undergoing initial ablation procedures for AF. LVAs were defined as regions with bipolar peak-to-peak voltages of <0.50 mV on the voltage map obtained during sinus rhythm after pulmonary vein isolation. During a 1-year follow-up period, 248 patients had a late recurrence of AF (LRAF), defined as recurrence within 3 to 12 months after ablation. The occurrence of VLRAF was examined in 711 patients without LRAF who were followed for more than 1 year. RESULTS A total of 711 patients who did not develop AF recurrence within 1 year and for whom clinical data were available after 1 year were analyzed. During a median follow-up of 25 (19, 37) months, VLRAF more than one year after the initial ablation was detected in 123 patients. On multivariate analysis, independent predictors of VLRAF were the existence of LVAs, female, left atrial diameter and early recurrence of AF. A Kaplan-Meier analysis showed that the AF-free survival rate was significantly lower in patients with LVAs than in those without LVAs within 1 year and on more than 1 year follow-up. (P<0.001) An additional Kaplan-Meier analysis of the incidence of VLRAF in propensity score-matched patients with and without LVAs showed that VLRAF occurred significantly more frequently in patients with LVAs. (P=0.003) CONCLUSIONS: LVAs during the initial AF ablation procedures have an impact on VLRAF occurrence. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Takashi Kanda
- Department of Cardiology, Osaka Police Hospital, Osaka, Japan.,Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Hyogo, Japan
| | - Masaharu Masuda
- Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Hyogo, Japan
| | - Mitsutoshi Asai
- Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Hyogo, Japan
| | - Osamu Iida
- Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Hyogo, Japan
| | - Shin Okamoto
- Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Hyogo, Japan
| | - Takayuki Ishihara
- Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Hyogo, Japan
| | - Kiyonori Nanto
- Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Hyogo, Japan
| | - Takuya Tsujimura
- Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Hyogo, Japan
| | - Yasuhiro Matsuda
- Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Hyogo, Japan
| | - Yosuke Hata
- Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Hyogo, Japan
| | - Hiroyuki Uematsu
- Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Hyogo, Japan
| | - Taku Toyoshima
- Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Hyogo, Japan
| | - Naoko Higashino
- Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Hyogo, Japan
| | - Toshiaki Mano
- Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Hyogo, Japan
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Stojanovic D, Mitic V, Stojanovic M, Milenkovic J, Ignjatovic A, Milojkovic M. The Scientific Rationale for the Introduction of Renalase in the Concept of Cardiac Fibrosis. Front Cardiovasc Med 2022; 9:845878. [PMID: 35711341 PMCID: PMC9193824 DOI: 10.3389/fcvm.2022.845878] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 04/25/2022] [Indexed: 12/17/2022] Open
Abstract
Cardiac fibrosis represents a redundant accumulation of extracellular matrix proteins, resulting from a cascade of pathophysiological events involved in an ineffective healing response, that eventually leads to heart failure. The pathophysiology of cardiac fibrosis involves various cellular effectors (neutrophils, macrophages, cardiomyocytes, fibroblasts), up-regulation of profibrotic mediators (cytokines, chemokines, and growth factors), and processes where epithelial and endothelial cells undergo mesenchymal transition. Activated fibroblasts and myofibroblasts are the central cellular effectors in cardiac fibrosis, serving as the main source of matrix proteins. The most effective anti-fibrotic strategy will have to incorporate the specific targeting of the diverse cells, pathways, and their cross-talk in the pathogenesis of cardiac fibroproliferation. Additionally, renalase, a novel protein secreted by the kidneys, is identified. Evidence demonstrates its cytoprotective properties, establishing it as a survival element in various organ injuries (heart, kidney, liver, intestines), and as a significant anti-fibrotic factor, owing to its, in vitro and in vivo demonstrated pleiotropy to alleviate inflammation, oxidative stress, apoptosis, necrosis, and fibrotic responses. Effective anti-fibrotic therapy may seek to exploit renalase’s compound effects such as: lessening of the inflammatory cell infiltrate (neutrophils and macrophages), and macrophage polarization (M1 to M2), a decrease in the proinflammatory cytokines/chemokines/reactive species/growth factor release (TNF-α, IL-6, MCP-1, MIP-2, ROS, TGF-β1), an increase in anti-apoptotic factors (Bcl2), and prevention of caspase activation, inflammasome silencing, sirtuins (1 and 3) activation, and mitochondrial protection, suppression of epithelial to mesenchymal transition, a decrease in the pro-fibrotic markers expression (’α-SMA, collagen I, and III, TIMP-1, and fibronectin), and interference with MAPKs signaling network, most likely as a coordinator of pro-fibrotic signals. This review provides the scientific rationale for renalase’s scrutiny regarding cardiac fibrosis, and there is great anticipation that these newly identified pathways are set to progress one step further. Although substantial progress has been made, indicating renalase’s therapeutic promise, more profound experimental work is required to resolve the accurate underlying mechanisms of renalase, concerning cardiac fibrosis, before any potential translation to clinical investigation.
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Affiliation(s)
- Dijana Stojanovic
- Institute of Pathophysiology, Faculty of Medicine, University of Niš, Niš, Serbia
| | - Valentina Mitic
- Department of Cardiovascular Rehabilitation, Institute for Treatment and Rehabilitation "Niska Banja", Niska Banja, Serbia
| | - Miodrag Stojanovic
- Department of Medical Statistics and Informatics, Faculty of Medicine, University of Niš, Niš, Serbia.,Center of Informatics and Biostatistics in Healthcare, Institute for Public Health, Niš, Serbia
| | - Jelena Milenkovic
- Institute of Pathophysiology, Faculty of Medicine, University of Niš, Niš, Serbia
| | - Aleksandra Ignjatovic
- Department of Medical Statistics and Informatics, Faculty of Medicine, University of Niš, Niš, Serbia.,Center of Informatics and Biostatistics in Healthcare, Institute for Public Health, Niš, Serbia
| | - Maja Milojkovic
- Institute of Pathophysiology, Faculty of Medicine, University of Niš, Niš, Serbia
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Kanda T, Masuda M, Asai M, Iida O, Okamoto S, Ishihara T, Nanto K, Tsujimura T, Matsuda Y, Hata Y, Uematsu H, Mano T. Extensive Left Atrial Low-Voltage Area During Initial Ablation is Associated with A Poor Clinical Outcome Even Following Multiple Procedures. J Atr Fibrillation 2021; 14:20200491. [PMID: 34950372 DOI: 10.4022/jafib.20200491] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 03/18/2021] [Accepted: 05/29/2021] [Indexed: 11/10/2022]
Abstract
Background Some patients fail to respond to persistent atrial fibrillation (PeAF) catheter ablation in spite of multiple procedures and ablation strategies, including low voltage area (LVA)-guided, linear, and complex fractionated atrial electrogram (CFAE)-guided ablation procedures. We hypothesized that LVA extent could predict non-responseto Pe AF catheter ablation in spite of multiple procedures. Methods This study included 510 patients undergoing initial ablation procedures for PeAF. LVAs were defined as regions with bipolar peak-to-peak voltages of <0.50 mV after PVI during sinus rhythm. Patients were categorized by LVA size into groups A(0-5 cm2), B (5-20 cm2), and C (over 20 cm2). The primary endpoint was AF-free survival after the last procedure. Results During a median follow-up of 25 (17, 36) months, AF recurrence was observed in 101 (20%) patients after 1.4±0.6 ablation procedures (maximum 4). Comparison of clinical outcomes after multiple procedures in the three groups showed that the results depended on the extent of LVA. Multivariate analysis of AF-free survival after the last procedure showed that LVAs > 20 cm2 was an independent factor associated with AF recurrence after the final procedure(Hazard ratio, 7.94; 95% confidence interval, 2.91 to 21.67, P <0.001). Conclusions Extensive LVA after initial PVI was associated with poor clinical benefit despite multiple catheter based ablations.
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Affiliation(s)
- Takashi Kanda
- Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Hyogo, Japan 3-1-69 Inabaso, Amagasaki, 660-8511, Japan
| | - Masaharu Masuda
- Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Hyogo, Japan 3-1-69 Inabaso, Amagasaki, 660-8511, Japan
| | - Mitsutoshi Asai
- Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Hyogo, Japan 3-1-69 Inabaso, Amagasaki, 660-8511, Japan
| | - Osamu Iida
- Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Hyogo, Japan 3-1-69 Inabaso, Amagasaki, 660-8511, Japan
| | - Shin Okamoto
- Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Hyogo, Japan 3-1-69 Inabaso, Amagasaki, 660-8511, Japan
| | - Takayuki Ishihara
- Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Hyogo, Japan 3-1-69 Inabaso, Amagasaki, 660-8511, Japan
| | - Kiyonori Nanto
- Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Hyogo, Japan 3-1-69 Inabaso, Amagasaki, 660-8511, Japan
| | - Takuya Tsujimura
- Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Hyogo, Japan 3-1-69 Inabaso, Amagasaki, 660-8511, Japan
| | - Yasuhiro Matsuda
- Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Hyogo, Japan 3-1-69 Inabaso, Amagasaki, 660-8511, Japan
| | - Yosuke Hata
- Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Hyogo, Japan 3-1-69 Inabaso, Amagasaki, 660-8511, Japan
| | - Hiroyuki Uematsu
- Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Hyogo, Japan 3-1-69 Inabaso, Amagasaki, 660-8511, Japan
| | - Toshiaki Mano
- Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Hyogo, Japan 3-1-69 Inabaso, Amagasaki, 660-8511, Japan
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Elzeneini M, Al-Ani M, Peters AE, Burdick MD, Yang N, Salerno M, Mehrad B, Keeley EC. Circulating fibrocyte levels correlate with infarct size in patients with ST elevation myocardial infarction treated with primary percutaneous coronary intervention. AMERICAN HEART JOURNAL PLUS: CARDIOLOGY RESEARCH AND PRACTICE 2021; 12. [PMID: 35079723 PMCID: PMC8786221 DOI: 10.1016/j.ahjo.2021.100071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Study objective: Infarct size is a strong predictor of outcomes after ST elevation myocardial infarction (STEMI). Circulating fibrocytes are bone marrow-derived progenitor cells associated with fibrotic processes. We tested whether fibrocytes correlate with infarct size in STEMI patients treated with primary percutaneous coronary intervention (PCI). Design: Prospective observational study. Setting: Academic medical center. Participants: Subjects with STEMI treated with primary PCI. Interventions: Peripheral blood draw and cardiac magnetic resonance imaging (CMR). Main outcome measure: Correlation of fibrocyte levels with infarct size. Methods: Peripheral blood fibrocytes were quantified at discharge from STEMI hospitalization and at 6 months follow-up using flow cytometry. Infarct size was determined within 2 weeks of discharge and at 6 months follow-up using late gadolinium enhancement on CMR. Results: Among 14 patients (median age 54 years, 79% men) with STEMI, there was a statistically significant positive correlation between fibrocyte levels at 6 months and 6-month infarct size on CMR (r = 0.58, p = 0.031). In addition, there was positive correlation between peak troponin I level (r = 0.85, p < 0.001), and white blood cell count (r = 0.55, p = 0.042) during the hospital stay and 6-month infarct size on CMR. Conclusions: Circulating fibrocytes measured 6 months after STEMI positively correlate with 6-month infarct size assessed by CMR.
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Palacio LC, Ugarte JP, Saiz J, Tobón C. The Effects of Fibrotic Cell Type and Its Density on Atrial Fibrillation Dynamics: An In Silico Study. Cells 2021; 10:cells10102769. [PMID: 34685750 PMCID: PMC8534881 DOI: 10.3390/cells10102769] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/03/2021] [Accepted: 10/12/2021] [Indexed: 12/12/2022] Open
Abstract
Remodeling in atrial fibrillation (AF) underlines the electrical and structural changes in the atria, where fibrosis is a hallmark of arrhythmogenic structural alterations. Fibrosis is an important feature of the AF substrate and can lead to abnormal conduction and, consequently, mechanical dysfunction. The fibrotic process comprises the presence of fibrotic cells, including fibroblasts, myofibroblasts and fibrocytes, which play an important role during fibrillatory dynamics. This work assesses the effect of the diffuse fibrosis density and the intermingled presence of the three types of fibrotic cells on the dynamics of persistent AF. For this purpose, the three fibrotic cells were electrically coupled to cardiomyocytes in a 3D realistic model of human atria. Low (6.25%) and high (25%) fibrosis densities were implemented in the left atrium according to a diffuse fibrosis representation. We analyze the action potential duration, conduction velocity and fibrillatory conduction patterns. Additionally, frequency analysis was performed in 50 virtual electrograms. The tested fibrosis configurations generated a significant conduction velocity reduction, where the larger effect was observed at high fibrosis density (up to 82% reduction in the fibrocytes configuration). Increasing the fibrosis density intensifies the vulnerability to multiple re-entries, zigzag propagation, and chaotic activity in the fibrillatory conduction. The most complex propagation patterns were observed at high fibrosis densities and the fibrocytes are the cells with the largest proarrhythmic effect. Left-to-right dominant frequency gradients can be observed for all fibrosis configurations, where the fibrocytes configuration at high density generates the most significant gradients (up to 4.5 Hz). These results suggest the important role of different fibrotic cell types and their density in diffuse fibrosis on the chaotic propagation patterns during persistent AF.
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Affiliation(s)
- Laura C. Palacio
- Materiales Nanoestructurados y Biomodelación (MATBIOM), Universidad de Medellín, Medellín 050032, Colombia;
| | - Juan P. Ugarte
- Grupo de Investigación en Modelamiento y Simulación Computacional (GIMSC), Universidad de San Buenaventura, Medellín 050010, Colombia;
| | - Javier Saiz
- Centro de Investigación e Innovación en Bioingeniería (CIB), Universitat Politècnica de València, 46022 Valencia, Spain;
| | - Catalina Tobón
- Materiales Nanoestructurados y Biomodelación (MATBIOM), Universidad de Medellín, Medellín 050032, Colombia;
- Correspondence:
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10
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Tan R, Yu H, Han X, Liu Y, Yang X, Xia YL, Yin X. Circulating Soluble Suppression of Tumorigenicity 2 Predicts Recurrence After Radiofrequency Ablation of Persistent Atrial Fibrillation. Front Cardiovasc Med 2021; 8:653312. [PMID: 34222362 PMCID: PMC8245690 DOI: 10.3389/fcvm.2021.653312] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 05/10/2021] [Indexed: 11/26/2022] Open
Abstract
Objective: A more extensively fibrotic left atrium contributes to atrial fibrillation (AF) occurrence, persistence, and recurrence. The soluble suppression of tumorigenicity 2 (sST2) has emerged as a ventricular fibrotic biomarker for patients with heart failure. The present study is to investigate associations between circulating sST2 and risk of recurrence after ablation in AF patients. Methods: We measured the baseline plasma level of sST2 from patients with persistent AF (n = 117) and paroxysmal AF (n = 93) patients. Patients were followed up for 15 months after ablation. The relationship between circulating sST2 and recurrence was assessed by multivariable Cox regression. The cutoff value of sST2 was determined by receiver operating characteristic curve. The relationship between baseline sST2 level and left atrial volume index (LAVI) was assessed by multivariate linear regression analysis. Serial sST2 measurements were also conducted after 24 h, 6 months, and 15 months of ablation. ST2 localization was examined in left atrial appendages of persistent AF patients by immunohistochemistry and Western blot. Results: Baseline sST2 positively associated with LAVI in the persistent AF group, and elevated sST2 (≥39.25 ng/ml) independently increased the risk of recurrence after ablation (area under the curve = 0.748), with hazard ratio of 1.038 (95% confidence interval 1.017–1.060, P < 0.001) when adjusted for co-variables. In contrast, elevated sST2 cannot predict recurrence in paroxysmal AF. Conclusions: In persistent AF patients, increased sST2 serves as a marker of recurrence after radiofrequency ablation. Patients with sST2 ≥ 39.25 ng/ml are more likely to develop recurrence within a year.
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Affiliation(s)
- Ruopeng Tan
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, China.,Institute of Cardiovascular Diseases, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Haixu Yu
- Department of Cardiology, Peking University Third Hospital, Beijing, China
| | - Xu Han
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yang Liu
- Institute of Cardiovascular Diseases, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Xiaolei Yang
- Institute of Cardiovascular Diseases, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yun-Long Xia
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, China.,Institute of Cardiovascular Diseases, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Xiaomeng Yin
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
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11
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Liu Y, Lv H, Tan R, An X, Niu XH, Liu YJ, Yang X, Yin X, Xia YL. Platelets Promote Ang II (Angiotensin II)-Induced Atrial Fibrillation by Releasing TGF-β1 (Transforming Growth Factor-β1) and Interacting With Fibroblasts. Hypertension 2020; 76:1856-1867. [PMID: 33175633 DOI: 10.1161/hypertensionaha.120.15016] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Hypertension is a risk factor of atrial fibrillation (AF), and a certain number of patients with hypertension were found with an enlarged left atrium. Platelet activation is found in patients with hypertension or pressure overload/Ang II (angiotensin II)-induced hypertensive animal models and contribute to ventricular fibrosis. Whether hypertension-induced atrial fibrosis is mediated by platelets remains unknown. Our previous experimental data showed that platelet-derived TGF-β1 (transforming growth factor-β1) was reduced in patients with hypertensive AF. The present study is to investigate whether platelet-derived TGF-β1 promotes Ang II-induced atrial fibrosis and AF. Platelet activation and atrial platelet accumulation were measured in sinus rhythm controls, normotensive AF, and patients with hypertensive AF. Ang II (1500 ng/kg per minute, 3 weeks) infused mice with pharmacological (clopidogrel) and genetic platelet inhibition (TGF-β1 deletion in platelets) were used. Platelet activation, atrial structural remodeling, atrial electrical transmission, AF inducibility, inflammation, and fibrosis were measured in mice. We found that circulating platelets were activated in patients with hypertensive AF. A large amount of platelet was accumulated in the atriums of patients with hypertensive AF. Both clopidogrel treatment and platelet-specific deletion of TGF-β1 attenuated Ang II-induced structural remodeling, atrial electrical transmission, AF inducibility, as well as atrial inflammation and fibrosis than mice without interventions. Furthermore, clopidogrel blocked atrial platelet accumulation and platelet-fibroblast conjugation. Platelets promoted atrial fibroblast differentiation in cell culture. Profibrotic actions of platelets are largely via activation of atrial fibroblasts by releasing TGF-β1 and inducing platelet-fibroblast conjugation, and platelet inhibition is sufficient to inhibit atrial fibrosis and AF inducibility.
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Affiliation(s)
- Yang Liu
- From the Institute of Heart and Vascular Diseases (Y.L., R.T., X.A., X.N., X.Y., Y.-L.X.), the First Affiliated Hospital of Dalian Medical University, China
| | - Haichen Lv
- Department of Cardiology (H.L., X.Y., Y.-L.X.), the First Affiliated Hospital of Dalian Medical University, China
| | - Ruopeng Tan
- From the Institute of Heart and Vascular Diseases (Y.L., R.T., X.A., X.N., X.Y., Y.-L.X.), the First Affiliated Hospital of Dalian Medical University, China
| | - Xiangbo An
- From the Institute of Heart and Vascular Diseases (Y.L., R.T., X.A., X.N., X.Y., Y.-L.X.), the First Affiliated Hospital of Dalian Medical University, China
| | - Xiao-Hui Niu
- From the Institute of Heart and Vascular Diseases (Y.L., R.T., X.A., X.N., X.Y., Y.-L.X.), the First Affiliated Hospital of Dalian Medical University, China.,Yixing People's Hospital, the Affiliated Hospital of Jiangsu University, China (X.N.)
| | - Yue-Jian Liu
- Central Laboratory (Y.-J.L.), the First Affiliated Hospital of Dalian Medical University, China
| | - Xiaolei Yang
- From the Institute of Heart and Vascular Diseases (Y.L., R.T., X.A., X.N., X.Y., Y.-L.X.), the First Affiliated Hospital of Dalian Medical University, China
| | - Xiaomeng Yin
- Department of Cardiology (H.L., X.Y., Y.-L.X.), the First Affiliated Hospital of Dalian Medical University, China
| | - Yun-Long Xia
- From the Institute of Heart and Vascular Diseases (Y.L., R.T., X.A., X.N., X.Y., Y.-L.X.), the First Affiliated Hospital of Dalian Medical University, China.,Department of Cardiology (H.L., X.Y., Y.-L.X.), the First Affiliated Hospital of Dalian Medical University, China
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12
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A specific combination of P wave duration and morphology accurately predicts the presence of left atrial low voltage area in patients with atrial fibrillation. J Electrocardiol 2020; 63:173-180. [DOI: 10.1016/j.jelectrocard.2019.10.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 10/03/2019] [Accepted: 10/11/2019] [Indexed: 01/03/2023]
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13
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Baci D, Bosi A, Parisi L, Buono G, Mortara L, Ambrosio G, Bruno A. Innate Immunity Effector Cells as Inflammatory Drivers of Cardiac Fibrosis. Int J Mol Sci 2020; 21:ijms21197165. [PMID: 32998408 PMCID: PMC7583949 DOI: 10.3390/ijms21197165] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 09/21/2020] [Accepted: 09/22/2020] [Indexed: 02/06/2023] Open
Abstract
Despite relevant advances made in therapies for cardiovascular diseases (CVDs), they still represent the first cause of death worldwide. Cardiac fibrosis and excessive extracellular matrix (ECM) remodeling are common end-organ features in diseased hearts, leading to tissue stiffness, impaired myocardial functional, and progression to heart failure. Although fibrosis has been largely recognized to accompany and complicate various CVDs, events and mechanisms driving and governing fibrosis are still not entirely elucidated, and clinical interventions targeting cardiac fibrosis are not yet available. Immune cell types, both from innate and adaptive immunity, are involved not just in the classical response to pathogens, but they take an active part in “sterile” inflammation, in response to ischemia and other forms of injury. In this context, different cell types infiltrate the injured heart and release distinct pro-inflammatory cytokines that initiate the fibrotic response by triggering myofibroblast activation. The complex interplay between immune cells, fibroblasts, and other non-immune/host-derived cells is now considered as the major driving force of cardiac fibrosis. Here, we review and discuss the contribution of inflammatory cells of innate immunity, including neutrophils, macrophages, natural killer cells, eosinophils and mast cells, in modulating the myocardial microenvironment, by orchestrating the fibrogenic process in response to tissue injury. A better understanding of the time frame, sequences of events during immune cells infiltration, and their action in the injured inflammatory heart environment, may provide a rationale to design new and more efficacious therapeutic interventions to reduce cardiac fibrosis.
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Affiliation(s)
- Denisa Baci
- Immunology and General Pathology Laboratory, Department of Biotechnology and Life Sciences, University of Insubria, 21100 Varese, Italy;
- Correspondence: (D.B.); (A.B.); Tel.:+39-02-5540-6648 (A.B.)
| | - Annalisa Bosi
- Laboratory of Pharmacology, Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy;
| | - Luca Parisi
- Department of Biomedical, Surgical and Dental Sciences, School of Dentistry, University of Milan, 20122 Milan, Italy;
| | - Giuseppe Buono
- Unit of Immunology, IRCCS MultiMedica, 20138 Milan, Italy;
| | - Lorenzo Mortara
- Immunology and General Pathology Laboratory, Department of Biotechnology and Life Sciences, University of Insubria, 21100 Varese, Italy;
| | - Giuseppe Ambrosio
- Division of Cardiology, University of Perugia School of Medicine, 06123 Perugia, Italy;
| | - Antonino Bruno
- Unit of Immunology, IRCCS MultiMedica, 20138 Milan, Italy;
- Correspondence: (D.B.); (A.B.); Tel.:+39-02-5540-6648 (A.B.)
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14
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Wang Z, Cheng L, Zhang J, Liang Z, Dong R, Hang F, Wang X, Wang Z, Wu Y, Du J. Serum-Soluble ST2 Is a Novel Biomarker for Evaluating Left Atrial Low-Voltage Zone in Paroxysmal Atrial Fibrillation. Med Sci Monit 2020; 26:e926221. [PMID: 32898129 PMCID: PMC7500126 DOI: 10.12659/msm.926221] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Paroxysmal atrial fibrillation (pAF) recurrence after radiofrequency catheter ablation (RFCA) is linked to low-voltage zone (LVZ). This study explored whether serum soluble ST2 (sST2) levels can predict the size of LVZs in patients with pAF. MATERIAL AND METHODS A total of 177 patients with pAF treated with RFCA were consecutively enrolled in this study. One hundred twenty-five patients (70.6%) with <20% LVZ were assigned to Group A, and 52 patients (29.4%) with a LVZ >20% were assigned to Group B. Levels of soluble ST2 (sST2), growth and differentiation factor (GDF-15) and tissue inhibitor of MMP1 (TIMP-1) were measured. RESULTS The sST2 levels were higher in Group B than in Group A (23.9±3.3 vs. 30.9±5.0 ng/mL, P<0.000). In multivariable logistic regression analysis, sST2 was the only independent parameter for predicting left atrial LVZ (odds ratio, 1.611 [1.379-1.882]; P<0.001). The cut-off value of sST2 obtained by receiver operating characteristic (ROC) analysis was 26.65 ng/mL for prediction of LVZ (sensitivity: 86.5%, specificity: 84.8%). The under-curve area was 0.895 (0.842-0.948) (P<0.001). At 12-month follow-up, patients with sST2 <26.65 ng/mL had more patients free from atrial arrhythmias compared to patients with sST2 >26.65 ng/mL (88.6% vs. 69.8%, P<0.01). CONCLUSIONS We demonstrated that sST2 levels are higher in pAF patients with LVZ >20% compared to those with a smaller LVZ. Also increased sST2 levels can serve as a novel predictor of AF recurrence rate in patients who have undergone RFCA.
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Affiliation(s)
- Zefeng Wang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China (mainland)
| | - Liting Cheng
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China (mainland)
| | - Junmeng Zhang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China (mainland)
| | - Zhuo Liang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China (mainland)
| | - Ruiqing Dong
- Department of Cardiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China (mainland)
| | - Fei Hang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China (mainland)
| | - Xinlu Wang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China (mainland)
| | - Ziyu Wang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China (mainland)
| | - Yongquan Wu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China (mainland)
| | - Jie Du
- Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, China (mainland)
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15
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Callegari S, Macchi E, Monaco R, Magnani L, Tafuni A, Croci S, Nicastro M, Garrapa V, Banchini A, Becchi G, Corradini E, Goldoni M, Rocchio F, Sala R, Benussi S, Ferrara D, Alfieri O, Corradi D. Clinicopathological Bird's-Eye View of Left Atrial Myocardial Fibrosis in 121 Patients With Persistent Atrial Fibrillation: Developing Architecture and Main Cellular Players. Circ Arrhythm Electrophysiol 2020; 13:e007588. [PMID: 32538131 DOI: 10.1161/circep.119.007588] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Scientific research on atrial fibrosis in atrial fibrillation (AF) has mainly focused on quantitative or molecular features. The purpose of this study was to perform a clinicoarchitectural/structural investigation of fibrosis to provide one key to understanding the electrophysiological/clinical aspects of AF. METHODS We characterized the fibrosis (amount, architecture, cellular components, and ultrastructure) in left atrial biopsies from 121 patients with persistent/long-lasting persistent AF (group 1; 59 males; 60±11 years; 91 mitral disease-related AF, 30 nonmitral disease-related AF) and from 39 patients in sinus rhythm with mitral valve regurgitation (group 2; 32 males; 59±12 years). Ten autopsy hearts served as controls. RESULTS Qualitatively, the fibrosis exhibited the same characteristics in all cases and displayed particular architectural scenarios (which we arbitrarily subdivided into 4 stages) ranging from isolated foci to confluent sclerotic areas. The percentage of fibrosis was larger and at a more advanced stage in group 1 versus group 2 and, within group 1, in patients with rheumatic disease versus nonrheumatic cases. In patients with AF with mitral disease and no rheumatic disease, the percentage of fibrosis and the fibrosis stages correlated with both left atrial volume index and AF duration. The fibrotic areas mainly consisted of type I collagen with only a minor cellular component (especially fibroblasts/myofibroblasts; average value range 69-150 cells/mm2, depending on the areas in AF biopsies). A few fibrocytes-circulating and bone marrow-derived mesenchymal cells-were also detectable. The fibrosis-entrapped cardiomyocytes showed sarcolemmal damage and connexin 43 redistribution/internalization. CONCLUSIONS Atrial fibrosis is an evolving and inhomogeneous histological/architectural change that progresses through different stages ranging from isolated foci to confluent sclerotic zones which-seemingly-constrain impulse conduction across restricted regions of electrotonically coupled cardiomyocytes. The fibrotic areas mainly consist of type I collagen extracellular matrix and, only to a lesser extent, mesenchymal cells.
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Affiliation(s)
- Sergio Callegari
- Center of Excellence for Toxicological Research (CERT) (S.C.), University of Parma, Italy
| | - Emilio Macchi
- Department of Chemistry, Life Sciences and Environmental Sustainability (E.M., L.M., V.G.), University of Parma, Italy
| | - Rodolfo Monaco
- Pathology Unit (R.M., A.T., G.B., E.C., D.C.), Department of Medicine and Surgery, University of Parma, Italy
| | - Luca Magnani
- Department of Chemistry, Life Sciences and Environmental Sustainability (E.M., L.M., V.G.), University of Parma, Italy
| | - Alessandro Tafuni
- Pathology Unit (R.M., A.T., G.B., E.C., D.C.), Department of Medicine and Surgery, University of Parma, Italy
| | - Stefania Croci
- Clinical Immunology, Allergy & Advanced Biotechnologies Unit, Azienda Unità, Sanitaria Locale-IRCCS, Reggio Emilia, Italy (S.C., M.N.)
| | - Maria Nicastro
- Clinical Immunology, Allergy & Advanced Biotechnologies Unit, Azienda Unità, Sanitaria Locale-IRCCS, Reggio Emilia, Italy (S.C., M.N.)
| | - Valentina Garrapa
- Department of Chemistry, Life Sciences and Environmental Sustainability (E.M., L.M., V.G.), University of Parma, Italy
| | - Antonio Banchini
- Forensic Medicine Unit (A.B.), Department of Medicine and Surgery, University of Parma, Italy
| | - Gabriella Becchi
- Pathology Unit (R.M., A.T., G.B., E.C., D.C.), Department of Medicine and Surgery, University of Parma, Italy
| | - Emilia Corradini
- Pathology Unit (R.M., A.T., G.B., E.C., D.C.), Department of Medicine and Surgery, University of Parma, Italy
| | - Matteo Goldoni
- Laboratory of Industrial Toxicology (M.G.), Department of Medicine and Surgery, University of Parma, Italy
| | - Francesca Rocchio
- International Centre for T1D, Paediatric Clinical Research Center Fondazione "Romeo ed Enrica Invernizzi", Department of Biomedical & Clinical Science, Hospital "L. Sacco", University of Milan, Italy (F.R.)
| | - Roberto Sala
- General Pathology Unit (R.S.), Department of Medicine and Surgery, University of Parma, Italy
| | | | - David Ferrara
- Cardiothoracic Surgery Unit, Department of Cardiology, San Raffaele University Hospital, Milan, Italy (D.F., O.A.)
| | - Ottavio Alfieri
- Cardiothoracic Surgery Unit, Department of Cardiology, San Raffaele University Hospital, Milan, Italy (D.F., O.A.)
| | - Domenico Corradi
- Pathology Unit (R.M., A.T., G.B., E.C., D.C.), Department of Medicine and Surgery, University of Parma, Italy
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16
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Niu XH, Xie YP, Yang S, Chen Y, Xu L, Zhang Y, Liu Y. IL-18/IL-18R1 promotes circulating fibrocyte differentiation in the aging population. Inflamm Res 2020; 69:497-507. [PMID: 32193584 DOI: 10.1007/s00011-020-01330-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 01/18/2020] [Accepted: 02/25/2020] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND Fibrosis in multiple organs increases with age. Circulating fibrocytes are bone-marrow-derived mesenchymal progenitors that contribute to heart, lung, and kidney fibrosis under the diseased conditions. Whether circulating fibrocytes contribute to aging-related fibrosis is very limited. METHODS AND RESULTS We measured the proportion and differentiation of circulating fibrocytes (CD45+/CD34+/collagen I+) from elders (n = 12) and adults (n = 12) using flow cytometry. Differentiated fibrocytes in the culture dishes were isolated and microarray was performed. The percentage of circulating fibrocytes in elders (1.95 ± 0.43%) was comparable to that in the adults (1.71 ± 0.38%). Cultured fibrocytes displayed enhanced potential of differentiation in the elder group (67.91 ± 5.88%) vs the adult group (44.03 ± 7.98%). In addition, expression of fibroblast activation markers and cell migratory ability were also increased in differentiated fibrocytes from elders. Microarray analysis revealed that differentiated fibrocytes from elders expressed high level of interleukin-18 (IL-18) receptor 1 (IL-18R1). Furthermore, we found IL-18 was elevated in the plasma of elders and IL-18/IL-18R1 was shown to promote fibrocyte differentiation. CONCLUSION Circulating fibrocytes from elders had an enhanced capacity to differentiate into myofibroblasts, and might contribute to age-dependent fibrosis. Age-dependent increment of differentiation at least in part arose from their enhanced expression of IL-18R1. Inhibiting fibrocyte differentiation might be useful as an adjuvant treatment to delay the fibrosis process in aging population.
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Affiliation(s)
- Xiao-Hui Niu
- Institute of Cardiovascular Diseases, The First Affiliated Hospital of Dalian Medical University, No 222, Zhongshan Rd, Dalian, China.,Yixing People's Hospital, The Affiliated Hospital of Jiangsu University, Yixing, China.,Department of Cardiology, the First Affiliated Hospital of Dalian Medical University, No 222, Zhongshan Rd, Dalian, China
| | - Yun-Peng Xie
- Institute of Cardiovascular Diseases, The First Affiliated Hospital of Dalian Medical University, No 222, Zhongshan Rd, Dalian, China
| | - Song Yang
- Yixing People's Hospital, The Affiliated Hospital of Jiangsu University, Yixing, China
| | - Yanchun Chen
- Yixing People's Hospital, The Affiliated Hospital of Jiangsu University, Yixing, China
| | - Liang Xu
- Yixing People's Hospital, The Affiliated Hospital of Jiangsu University, Yixing, China
| | - Ying Zhang
- Department of Cardiology, the First Affiliated Hospital of Dalian Medical University, No 222, Zhongshan Rd, Dalian, China.
| | - Yang Liu
- Institute of Cardiovascular Diseases, The First Affiliated Hospital of Dalian Medical University, No 222, Zhongshan Rd, Dalian, China.
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17
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Yi Y, Du L, Qin M, Chen XQ, Sun XN, Li C, Du LJ, Liu Y, Liu Y, Sun JY, Tang Z, Xu M, Fang B, Liu X, Duan SZ. Regulation of Atrial Fibrosis by the Bone. Hypertension 2019; 73:379-389. [PMID: 30595118 DOI: 10.1161/hypertensionaha.118.11544] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
MR (mineralocorticoid receptor) antagonists have been demonstrated to provide beneficial effects on preventing atrial fibrosis. However, the underlying cellular and molecular mechanisms remain unclear. We aim to determine the role of osteoblast MR in atrial fibrosis and to explore the underlying mechanism. Using osteoblast MR knockout mouse in combination with mutant TGF (transforming growth factor)-β1 transgenic mouse, we demonstrated that MR deficiency in osteoblasts significantly attenuated atrial fibrosis. Mechanistically, MR directly regulated expression of OCN (osteocalcin) in osteoblasts. Both carboxylated and undercarboxylated OCNs (ucOC) were less secreted in osteoblast MR knockout mice. Mutant TGF-β1 transgenic mice supplemented with recombinant ucOC showed aggravated atrial fibrosis. In cultured atrial fibroblasts, ucOC treatment promoted proliferation and migration of atrial fibroblasts, whereas cotreatment with an antagonist for a GPRC6A (G-protein-coupled receptor, family C, group 6, member A) abolished these effects. Western blotting analysis revealed upregulation of PKA (protein kinase A) and CREB (cAMP-response element-binding protein) phosphorylation after ucOC treatment. Inhibition of PKA with its antagonist reduced ucOC-induced proliferation and migration of atrial fibroblasts. Finally, the impact of osteoblast MR deficiency on atrial fibrosis was abolished by ucOC administration in mutant TGF-β1 transgenic mice. Taken together, MR deficiency in osteoblasts attenuated atrial fibrosis by downregulation of OCN to promote proliferation and migration of atrial fibroblasts.
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Affiliation(s)
- Yi Yi
- From the Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, China (Y.Y., L.D., M.Q., X.-Q.C., X.L.)
| | - Lili Du
- From the Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, China (Y.Y., L.D., M.Q., X.-Q.C., X.L.)
| | - Mu Qin
- From the Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, China (Y.Y., L.D., M.Q., X.-Q.C., X.L.)
| | - Xiao-Qing Chen
- From the Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, China (Y.Y., L.D., M.Q., X.-Q.C., X.L.)
| | - Xue-Nan Sun
- National Clinical Research Center for Oral Diseases, China (X.-N.S., L.-J.D., Yuan Liu, Yan Liu, J.-Y.S., Z.T., M.X., B.F., S.-Z.D.).,Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, China (X.-N.S., L.-J.D., Yuan Liu, Yan Liu, J.-Y.S., Z.T., M.X., B.F., S.-Z.D.).,Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, University of the Chinese Academy of Sciences (X.-N.S., Yuan Liu).,Laboratory of Oral Microbiota and Systemic Diseases (X.-N.S., L.-J.D., Yuan Liu, Yan Liu, J.-Y.S., S.-Z.D.), Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, China
| | - Chao Li
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (C.L.)
| | - Lin-Juan Du
- National Clinical Research Center for Oral Diseases, China (X.-N.S., L.-J.D., Yuan Liu, Yan Liu, J.-Y.S., Z.T., M.X., B.F., S.-Z.D.).,Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, China (X.-N.S., L.-J.D., Yuan Liu, Yan Liu, J.-Y.S., Z.T., M.X., B.F., S.-Z.D.).,Laboratory of Oral Microbiota and Systemic Diseases (X.-N.S., L.-J.D., Yuan Liu, Yan Liu, J.-Y.S., S.-Z.D.), Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, China
| | - Yuan Liu
- National Clinical Research Center for Oral Diseases, China (X.-N.S., L.-J.D., Yuan Liu, Yan Liu, J.-Y.S., Z.T., M.X., B.F., S.-Z.D.).,Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, China (X.-N.S., L.-J.D., Yuan Liu, Yan Liu, J.-Y.S., Z.T., M.X., B.F., S.-Z.D.).,Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, University of the Chinese Academy of Sciences (X.-N.S., Yuan Liu).,Laboratory of Oral Microbiota and Systemic Diseases (X.-N.S., L.-J.D., Yuan Liu, Yan Liu, J.-Y.S., S.-Z.D.), Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, China
| | - Yan Liu
- National Clinical Research Center for Oral Diseases, China (X.-N.S., L.-J.D., Yuan Liu, Yan Liu, J.-Y.S., Z.T., M.X., B.F., S.-Z.D.).,Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, China (X.-N.S., L.-J.D., Yuan Liu, Yan Liu, J.-Y.S., Z.T., M.X., B.F., S.-Z.D.).,Laboratory of Oral Microbiota and Systemic Diseases (X.-N.S., L.-J.D., Yuan Liu, Yan Liu, J.-Y.S., S.-Z.D.), Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, China
| | - Jian-Yong Sun
- National Clinical Research Center for Oral Diseases, China (X.-N.S., L.-J.D., Yuan Liu, Yan Liu, J.-Y.S., Z.T., M.X., B.F., S.-Z.D.).,Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, China (X.-N.S., L.-J.D., Yuan Liu, Yan Liu, J.-Y.S., Z.T., M.X., B.F., S.-Z.D.).,Laboratory of Oral Microbiota and Systemic Diseases (X.-N.S., L.-J.D., Yuan Liu, Yan Liu, J.-Y.S., S.-Z.D.), Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, China
| | - Zisheng Tang
- National Clinical Research Center for Oral Diseases, China (X.-N.S., L.-J.D., Yuan Liu, Yan Liu, J.-Y.S., Z.T., M.X., B.F., S.-Z.D.).,Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, China (X.-N.S., L.-J.D., Yuan Liu, Yan Liu, J.-Y.S., Z.T., M.X., B.F., S.-Z.D.).,Department of Endodontics (Z.T.), Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, China
| | - Min Xu
- National Clinical Research Center for Oral Diseases, China (X.-N.S., L.-J.D., Yuan Liu, Yan Liu, J.-Y.S., Z.T., M.X., B.F., S.-Z.D.).,Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, China (X.-N.S., L.-J.D., Yuan Liu, Yan Liu, J.-Y.S., Z.T., M.X., B.F., S.-Z.D.).,Department of Orthodontics (M.X., B.F.), Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, China
| | - Bing Fang
- National Clinical Research Center for Oral Diseases, China (X.-N.S., L.-J.D., Yuan Liu, Yan Liu, J.-Y.S., Z.T., M.X., B.F., S.-Z.D.).,Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, China (X.-N.S., L.-J.D., Yuan Liu, Yan Liu, J.-Y.S., Z.T., M.X., B.F., S.-Z.D.).,Department of Orthodontics (M.X., B.F.), Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, China
| | - Xu Liu
- From the Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, China (Y.Y., L.D., M.Q., X.-Q.C., X.L.)
| | - Sheng-Zhong Duan
- National Clinical Research Center for Oral Diseases, China (X.-N.S., L.-J.D., Yuan Liu, Yan Liu, J.-Y.S., Z.T., M.X., B.F., S.-Z.D.).,Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, China (X.-N.S., L.-J.D., Yuan Liu, Yan Liu, J.-Y.S., Z.T., M.X., B.F., S.-Z.D.).,Laboratory of Oral Microbiota and Systemic Diseases (X.-N.S., L.-J.D., Yuan Liu, Yan Liu, J.-Y.S., S.-Z.D.), Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, China
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18
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Abstract
The authors discuss the concept of atrial myopathy; its relationship to aging, electrophysiological remodeling, and autonomic remodeling; the interplay between atrial myopathy, AF, and stroke; and suggest how to identify patients with atrial myopathy and how to incorporate atrial myopathy into decisions about anticoagulation. Atrial myopathy seen in animal models of AF and in patients with AF is the result of a combination of factors that lead to electrical and structural remodeling in the atrium. Although AF may lead to the initiation and/or progression of this myopathy, the presence of AF is by no means essential to the development or the maintenance of the atrial myopathic state. Methods to identify atrial myopathy include atrial electrograms, tissue biopsy, cardiac imaging, and certain serum biomarkers. A promising modality is 4-dimensional flow cardiac magnetic resonance. The concept of atrial myopathy may help guide oral anticoagulant therapy in selected groups of patients with AF, particularly those with low to intermediate risk of strokes and those who have undergone successful AF ablation. This review highlights the need for prospective randomized trials to test these hypotheses.
This paper discusses the evolving concept of atrial myopathy by presenting how it develops and how it affects the properties of the atria. It also reviews the complex relationships among atrial myopathy, atrial fibrillation (AF), and stroke. Finally, it discusses how to apply the concept of atrial myopathy in the clinical setting—to identify patients with atrial myopathy and to be more selective in anticoagulation in a subset of patients with AF. An apparent lack of a temporal relationship between episodes of paroxysmal AF and stroke in patients with cardiac implantable electronic devices has led investigators to search for additional factors that are responsible for AF-related strokes. Multiple animal models and human studies have revealed a close interplay of atrial myopathy, AF, and stroke via various mechanisms (e.g., aging, inflammation, oxidative stress, and stretch), which, in turn, lead to fibrosis, electrical and autonomic remodeling, and a pro-thrombotic state. The complex interplay among these mechanisms creates a vicious cycle of ever-worsening atrial myopathy and a higher risk of more sustained AF and strokes. By highlighting the importance of atrial myopathy and the risk of strokes independent of AF, this paper reviews the methods to identify patients with atrial myopathy and proposes a way to incorporate the concept of atrial myopathy to guide anticoagulation in patients with AF.
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Key Words
- 4D, 4 dimensional
- AF, atrial fibrillation
- APD, action potential duration
- CMR, cardiac magnetic resonance
- CRP, C-reactive protein
- Ca2+, calcium
- Cx, connexin
- GDF, growth differentiation factor
- IL, interleukin
- K+, potassium
- LA, left atrial
- LAA, left atrial appendage
- NADPH, nicotinamide adenine dinucleotide phosphate
- NOX2, catalytic, membrane-bound subunit of NADPH oxidase
- NT-proBNP, N-terminal pro B-type natriuretic peptide
- OAC, oral anticoagulant
- ROS, reactive oxygen species
- TGF, transforming growth factor
- TNF, tumor necrosis factor
- atrial fibrillation
- atrial myopathy
- electrophysiology
- thrombosis
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Affiliation(s)
- Mark J Shen
- Feinberg Cardiovascular and Renal Research Institute, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.,Cardiac Electrophysiology, Prairie Heart Institute of Illinois, HSHS St. John's Hospital, Springfield, Illinois
| | - Rishi Arora
- Feinberg Cardiovascular and Renal Research Institute, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - José Jalife
- Center for Arrhythmia Research, University of Michigan, Ann Arbor, Michigan.,Centro Nacional de Investigaciones Cardiovasculares, Carlos III (CNIC), and CIBERCV, Madrid, Spain
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19
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Li B, Luo F, Luo X, Li B, Qi L, Zhang D, Tang Y. Effects of atrial fibrosis induced by mitral regurgitation on atrial electrophysiology and susceptibility to atrial fibrillation in pigs. Cardiovasc Pathol 2019; 40:32-40. [DOI: 10.1016/j.carpath.2019.01.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 01/22/2019] [Accepted: 01/23/2019] [Indexed: 01/28/2023] Open
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20
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Goette A, Auricchio A, Boriani G, Braunschweig F, Terradellas JB, Burri H, Camm AJ, Crijns H, Dagres N, Deharo JC, Dobrev D, Hatala R, Hindricks G, Hohnloser SH, Leclercq C, Lewalter T, Lip GYH, Merino JL, Mont L, Prinzen F, Proclemer A, Pürerfellner H, Savelieva I, Schilling R, Steffel J, van Gelder IC, Zeppenfeld K, Zupan I, Heidbüchel H, Boveda S, Defaye P, Brignole M, Chun J, Guerra Ramos JM, Fauchier L, Svendsen JH, Traykov VB, Heinzel FR. EHRA White Paper: knowledge gaps in arrhythmia management—status 2019. Europace 2019; 21:993-994. [DOI: 10.1093/europace/euz055] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 03/15/2019] [Indexed: 12/23/2022] Open
Abstract
Abstract
Clinicians accept that there are many unknowns when we make diagnostic and therapeutic decisions. Acceptance of uncertainty is essential for the pursuit of the profession: bedside decisions must often be made on the basis of incomplete evidence. Over the years, physicians sometimes even do not realize anymore which the fundamental gaps in our knowledge are. As clinical scientists, however, we have to halt and consider what we do not know yet, and how we can move forward addressing those unknowns. The European Heart Rhythm Association (EHRA) believes that scanning the field of arrhythmia / cardiac electrophysiology to identify knowledge gaps which are not yet the subject of organized research, should be undertaken on a regular basis. Such a review (White Paper) should concentrate on research which is feasible, realistic, and clinically relevant, and should not deal with futuristic aspirations. It fits with the EHRA mission that these White Papers should be shared on a global basis in order to foster collaborative and needed research which will ultimately lead to better care for our patients. The present EHRA White Paper summarizes knowledge gaps in the management of atrial fibrillation, ventricular tachycardia/sudden death and heart failure.
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Affiliation(s)
- Andreas Goette
- St. Vincenz-Krankenhaus GmbH, Cardiology and Intensive Care Medicine, Am Busdorf 2, Paderborn, Germany
- Working Group Molecular Electrophysiology, University Hospital Magdeburg, Magdeburg, Germany
| | - Angelo Auricchio
- Department of Cardiology, Fondazione Cardiocentro Ticino, Lugano (Ticino), Switzerland
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | | | | | - Haran Burri
- Department of Cardiology, University Hospital of Geneva, Geneva, Switzerland
| | - A John Camm
- St. George's, University of London, Molecular and Clinical Sciences Research Institute, London, UK
| | - Harry Crijns
- Department of Cardiology and Cardiovascular Research Institute Maastricht (CARIM), Maastricht UMC+, Maastricht, The Netherlands
| | - Nikolaos Dagres
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Jean-Claude Deharo
- Department of Cardiology, Aix Marseille Université, CHU la Timone, Marseille, France
| | - Dobromir Dobrev
- University Duisburg-Essen, Institute of Pharmacology, Essen, Germany
| | - Robert Hatala
- Department of Cardiology and Angiology, National Cardiovascular Institute, NUSCH, Bratislava, Slovak Republic
| | - Gerhard Hindricks
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Stefan H Hohnloser
- Division of Clinical Electrophysiology, Department of Cardiology, J.W. Goethe University, Frankfurt, Germany
| | | | - Thorsten Lewalter
- Department of Cardiology and Intensive Care, Hospital for Internal Medicine Munich South, Munich, Germany
- Department of Cardiology, University of Bonn, Bonn, Germany
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Jose Luis Merino
- Hospital Universitario La Paz, Arrhythmia and Robotic EP Unit, Madrid, Spain
| | - Lluis Mont
- Department of Cardiology, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Frits Prinzen
- Department of Physiology, Maastricht University, Maastricht, Netherlands
| | | | - Helmut Pürerfellner
- Department of Cardiology, Ordensklinikum Linz Elisabethinen, Academic Teaching Hospital, Linz, Austria
| | - Irina Savelieva
- St. George's, University of London, Molecular and Clinical Sciences Research Institute, London, UK
| | | | - Jan Steffel
- University Heart Center Zurich, Zurich, Switzerland
| | - Isabelle C van Gelder
- Department Of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Katja Zeppenfeld
- Department of Cardiology, Leiden University Medical Center (Lumc), Leiden, Netherlands
| | - Igor Zupan
- Department Of Cardiology, University Clinical Centre Ljubljana, Ljubljana, Slovenia
| | - Hein Heidbüchel
- Antwerp University and Antwerp University Hospital, Antwerp, Belgium
| | - Serge Boveda
- Cardiology Department, Clinique Pasteur, Toulouse, France
| | - Pascal Defaye
- CHU Hôpital Albert Michalon, Unité de Rythmologie Service De Cardiologie, FR-38043 Grenoble Cedex 09, France
| | - Michele Brignole
- Department of Cardiology, Ospedali Del Tigullio, Via Don Bobbio 25, IT-16033 Lavagna (GE), Italy
| | - Jongi Chun
- CCB, Cardiology Department, Med. Klinik Iii, Markuskrankenhaus, Wilhelm Epstein Str. 4, DE-60431 Frankfurt, Germany
| | | | - Laurent Fauchier
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Université de Tours, Faculté de Médecine, Tours, France
| | - Jesper Hastrup Svendsen
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Vassil B Traykov
- Department of Invasive Electrophysiology and Cardiac Pacing, Clinic of Cardiology, Acibadem City Clinic Tokuda Hospital, Sofia, Bulgaria
| | - Frank R Heinzel
- Charité University Medicine, Campus Virchow-Klinikum, Berlin, Germany
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21
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Rosenberg JH, Werner JH, Plitt GD, Noble VV, Spring JT, Stephens BA, Siddique A, Merritt-Genore HL, Moulton MJ, Agrawal DK. Immunopathogenesis and biomarkers of recurrent atrial fibrillation following ablation therapy in patients with preexisting atrial fibrillation. Expert Rev Cardiovasc Ther 2019; 17:193-207. [PMID: 30580643 PMCID: PMC6386629 DOI: 10.1080/14779072.2019.1562902] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 12/20/2018] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Recurrent atrial fibrillation (RAF) following ablation therapy occurs in about 50% of patients. The pathogenesis of RAF is unknown, but is believed to be driven by atrial remodeling in the setting of background inflammation. Structural, electrophysiological and mechanical remodeling has been associated with atrial fibrillation (AF). Inflammation and fibrotic remodeling are the major factors perpetuating AF, as mediators released from the atrial tissues and cardiomyocytes due to mechanical and surgical injury could initiate the inflammatory process. In this article, we have critically reviewed the key mediators that may serve as potential biomarkers to predict RAF. Areas covered: Damage associated molecular patterns, heat shock proteins, inflammatory cytokines, non-inflammatory markers, markers of inflammatory cell activity, and markers of collagen deposition and metabolism are evaluated as potential biomarkers with molecular treatment options in RAF. Expert commentary: Establishing biomarkers to predict RAF could be useful in reducing morbidity and mortality. Investigations into the role of DAMPs participating in a sterile immune response may provide greater insight into the pathogenesis of RAF. Markers evaluating immune cell activity, collagen deposition, and levels of heat shock proteins show the greatest promise as potential biomarkers to predict RAF and develop novel therapies.
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Affiliation(s)
- John H Rosenberg
- Department of Clinical and Translational Science, Creighton University School of Medicine, Omaha, NE USA
| | - John H Werner
- Department of Clinical and Translational Science, Creighton University School of Medicine, Omaha, NE USA
| | - Gilman D Plitt
- Department of Clinical and Translational Science, Creighton University School of Medicine, Omaha, NE USA
| | - Victoria V Noble
- Department of Clinical and Translational Science, Creighton University School of Medicine, Omaha, NE USA
| | - Jordan T Spring
- Department of Clinical and Translational Science, Creighton University School of Medicine, Omaha, NE USA
| | - Brooke A Stephens
- Department of Clinical and Translational Science, Creighton University School of Medicine, Omaha, NE USA
| | - Aleem Siddique
- Department of Cardiothoracic Surgery, University of Nebraska Medical Center, Omaha, NE USA
| | | | - Michael J Moulton
- Department of Cardiothoracic Surgery, University of Nebraska Medical Center, Omaha, NE USA
| | - Devendra K Agrawal
- Department of Clinical and Translational Science, Creighton University School of Medicine, Omaha, NE USA
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22
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Hijioka N, Kamioka M, Matsumoto Y, Nodera M, Yamada S, Kaneshiro T, Yoshihisa A, Ishida T, Takeishi Y. Clinical impact of insulin resistance on pulmonary vein isolation outcome in patients with paroxysmal atrial fibrillation. J Cardiovasc Electrophysiol 2019; 30:479-486. [PMID: 30575179 DOI: 10.1111/jce.13827] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 12/10/2018] [Accepted: 12/18/2018] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The relationship between insulin resistance and atrial fibrillation (AF) recurrence after pulmonary vein isolation (PVI) remains unclear. METHODS Drug-refractory 114 paroxysmal AF patients (89 males, 62 ± 8 years) who underwent successful PVI were enrolled. Homeostasis model assessment of insulin resistance (HOMA-IR) was calculated and a value of ≥2.5 was defined as insulin resistant. The left atrial volume index (LAVI) was measured using echocardiography before and 1 year after PVI. Tumor necrosis factor-α (TNF-α) and TGF-β1 serum levels were measured before PVI, and the left atrium (LA) conduction velocity was calculated. The patients were divided into two groups (group 1: HOMA-IR < 2.5, n = 81; group 2: HOMA-IR ≥ 2.5, n = 33). RESULTS The LAVI between the two groups before PVI did not significantly differ (P > 0.05), nor did TNF-α (7.7 ± 2.0 vs 7.5 ± 1.0 pg/mL; P = 0.149) or TGF-β1 (28.4 ± 12.0 vs 27.6 ± 10.3 ng/mL; P = 0.757). LAVI before and 1 year after PVI in each group did not change. The conduction velocity of group 2 was slower than that of group 1 (0.7 ± 0.1 vs 1.1 ± 0.3 m/s, P < 0.001). Kaplan-Meier analysis showed significantly higher AF recurrence in group 2 than that in group 1 ( P = 0.019). Cox multivariable analysis revealed that insulin resistance was an independent predictor of recurrence (hazard ratio 1.287, P = 0.004). CONCLUSION Our results suggest that insulin resistance promotes LA electrical remodeling and might be related to AF recurrence after PVI.
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Affiliation(s)
- Naoko Hijioka
- Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
| | - Masashi Kamioka
- Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
| | - Yoshiyuki Matsumoto
- Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
| | - Minoru Nodera
- Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
| | - Shinya Yamada
- Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
| | - Takashi Kaneshiro
- Department of Arrhythmia and Cardiac Pacing, Fukushima Medical University, Fukushima, Japan
| | - Akiomi Yoshihisa
- Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
| | - Takafumi Ishida
- Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
| | - Yasuchika Takeishi
- Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
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