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Arabia G, Bellicini MG, Cersosimo A, Memo M, Mazzarotto F, Inciardi RM, Cerini M, Chen LY, Aboelhassan M, Benzoni P, Mitacchione G, Bontempi L, Curnis A. Ion channel dysfunction and fibrosis in atrial fibrillation: Two sides of the same coin. Pacing Clin Electrophysiol 2024; 47:417-428. [PMID: 38375940 DOI: 10.1111/pace.14944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 01/10/2024] [Accepted: 01/23/2024] [Indexed: 02/21/2024]
Abstract
BACKGROUND Atrial fibrillation (AF) is a common heart rhythm disorder that is associated with an increased risk of stroke and heart failure (HF). Initially, an association between AF and ion channel dysfunction was identified, classifying the pathology as a predominantly electrical disease. More recently it has been recognized that fibrosis and structural atrial remodeling play a driving role in the development of this arrhythmia also in these cases. PURPOSE Understanding the role of fibrosis in genetic determined AF could be important to better comprise the pathophysiology of this arrhythmia and to refine its management also in nongenetic forms. In this review we analyze genetic and epigenetic mechanisms responsible for AF and their link with atrial fibrosis, then we will consider analogies with the pathophysiological mechanism in nongenetic AF, and discuss consequent therapeutic options.
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Affiliation(s)
- Gianmarco Arabia
- Cardiology Department, Spedali Civili Hospital, University of Brescia, Brescia, Italy
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | | | - Angelica Cersosimo
- Cardiology Department, Spedali Civili Hospital, University of Brescia, Brescia, Italy
| | - Maurizio Memo
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Francesco Mazzarotto
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
- National Heart and Lung Institute, Imperial College London (F.M., J. Ware), London, UK
| | | | - Manuel Cerini
- Cardiology Department, Spedali Civili Hospital, University of Brescia, Brescia, Italy
| | - Lin Yee Chen
- University of Minnesota (L.Y.C.), Minneapolis, USA
| | | | - Patrizia Benzoni
- Department of Biosciences, Università degli Studi di Milano, Milan, Italy
| | | | - Luca Bontempi
- Unit of Cardiology, Cardiac Electrophysiology and, Electrostimulation Laboratory, "Bolognini" Hospital of Seriate - ASST Bergamo Est, Bergamo, Italy
| | - Antonio Curnis
- Cardiology Department, Spedali Civili Hospital, University of Brescia, Brescia, Italy
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
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Sheng J, Yang Z, Xu M, Meng J, Gong M, Miao Y. A prediction model based on functional mitral regurgitation for the recurrence of paroxysmal atrial fibrillation (PAF) after post-circular pulmonary vein radiofrequency ablation (CPVA). Echocardiography 2022; 39:1501-1511. [PMID: 36376256 PMCID: PMC10098807 DOI: 10.1111/echo.15479] [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: 04/20/2022] [Revised: 09/19/2022] [Accepted: 10/08/2022] [Indexed: 11/16/2022] Open
Abstract
AIM To construct a prediction model based on functional mitral regurgitation (FMR) in patients with paroxysmal atrial fibrillation (PAF) to predict atrial fibrillation recurrence after the post-circular pulmonary vein radiofrequency ablation (CPVA). METHODS We retrospectively analyzed 289 patients with PAF who underwent CPVA for the first time. The patients were randomly divided into modeling group and verification group at the ratio of 75:25. In the modeling group, the multivariate logistic regression was used to analyze and construct a prediction model for post-CPVA recurrence in PAF patients, which was then validated in the verification group. RESULTS (1) After 3-6 months of follow-up, the patients were divided into sinus rhythm group (252 cases) and recurrence group (24 cases); (2) In the modeling group, the age, left atrial diameter (LAD), and the degree of MR (mild, moderate, severe) were higher in recurrence group than that of the sinus rhythm group, and the left atrial appendage emptying velocity (LAAV) was lower in recurrence group (all p < .05). (3) A model for predicting the recurrence of PAF after radiofrequency ablation was constructed in the modeling group. The equation was: Logit(P) = -3.253 + .092 × age + 1.263 × mild MR + 2.325 × moderate MR + 5.111 × severe MR -.113 × LAAV. The area under the curve (AUC) of the model was .889 in modeling group and .866 in verification group, and the difference was not statistically significant (p > .05). CONCLUSION The prediction model of atrial fibrillation (AF) recurrence after CPVA in PAF patients has good predictive efficacy, specificity, and accuracy.
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Affiliation(s)
- Jingyu Sheng
- Department of Electrocardiography, Wujin Hospital Affiliated with Jiangsu University, The Wujin Clinical college of Xuzhou Medical University, Changzhou, China.,Department of Cardiovascular Division, The Third Affiliated Hospital of Soochow University, Chang Zhou, China
| | - Zhenni Yang
- Department of Cardiovascular Division, The Third Affiliated Hospital of Soochow University, Chang Zhou, China
| | - Min Xu
- Department of Cardiovascular Division, The Third Affiliated Hospital of Soochow University, Chang Zhou, China
| | - Jun Meng
- Department of Cardiovascular Division, The Third Affiliated Hospital of Soochow University, Chang Zhou, China
| | - Mingxia Gong
- Department of Cardiovascular Division, The Third Affiliated Hospital of Soochow University, Chang Zhou, China
| | - Yuxia Miao
- Department of Cardiovascular Division, The Third Affiliated Hospital of Soochow University, Chang Zhou, China
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Rafaqat S, Afzal S, Khurshid H, Safdar S, Rafaqat S, Rafaqat S. The Role of Major Inflammatory Biomarkers in the Pathogenesis of Atrial Fibrillation. J Innov Card Rhythm Manag 2022; 13:5265-5277. [PMID: 37293559 PMCID: PMC10246921 DOI: 10.19102/icrm.2022.13125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 06/27/2022] [Indexed: 12/01/2023] Open
Abstract
Many studies have reported a relationship between inflammation and atrial fibrillation (AF). According to the literature, inflammation is the key component in pathophysiological processes during the development of AF; the amplification of inflammatory pathways triggers AF, and, at the same time, AF increases the inflammatory state. The plasma levels of several inflammatory biomarkers are elevated in patients with AF; therefore, inflammation might contribute to both the maintenance and occurrence of AF and its thromboembolic complications. Numerous inflammatory markers have been linked to AF, including CD40 ligand, fibrinogen, matrix metalloproteinase (MMP)-9, monocyte chemoattractant protein-1, myeloperoxidase, plasminogen activator inhibitor-1, and serum amyloid A. There are many pathophysiological aspects of AF that are linked to these inflammatory biomarkers, including atrial structural remodeling and atrial dilatation, increased atrial myocyte expression, fluctuations in calcium cycling, cardiac remodeling promotion, increased cardiac myocyte proliferation and terminal differentiation, production of several MMPs, the pathogenesis of atherosclerosis and cardiomyocyte apoptosis, an increased degree of fibrosis in atrial myocardium, and the progression and development of atherogenesis and atherothrombosis. The present review article aims to provide an updated overview and focus on the basic role of different biomarkers of inflammation in the pathophysiological aspects of the pathogenesis of AF.
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Affiliation(s)
- Saira Rafaqat
- Lahore College for Women University, Lahore, Pakistan
| | | | - Huma Khurshid
- Lahore College for Women University, Lahore, Pakistan
| | | | - Sana Rafaqat
- Lahore College for Women University, Lahore, Pakistan
| | - Simon Rafaqat
- Forman Christian College (A Chartered University), Lahore, Pakistan
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Li H, Sun W, Wang Z, Wang Z, Du X, Chen J, Gao J, Liu X, Wang X, Wang Y, Wu Y, Zhang X. Higher serum tissue inhibitor of metalloproteinase-1 predicts atrial fibrillation recurrence after radiofrequency catheter ablation. Front Cardiovasc Med 2022; 9:961914. [PMID: 36312240 PMCID: PMC9606231 DOI: 10.3389/fcvm.2022.961914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Accepted: 09/20/2022] [Indexed: 11/13/2022] Open
Abstract
Background Tissue inhibitor of metalloproteinase-1 (TIMP-1) levels is strongly associated with cardiac extracellular matrix accumulation and atrial fibrosis. Whether serum levels of TIMP-1 are associated with atrial fibrillation (AF) recurrence following radiofrequency catheter ablation (RFCA) remains unknown. Materials and methods Serum TIMP-1 levels of patients with AF before they underwent initial RFCA were measured using ELISA. Univariate and multivariate-adjusted Cox models were constructed to determine the relationship between TIMP-1 levels and AF recurrence. Multivariate logistic regression analyses were performed to determine predictors of AF recurrence. Results Of the 194 enrolled patients, 61 (31.4%) had AF recurrence within the median 30.0 months (interquartile range: 16.5–33.7 months) of follow-up. These patients had significantly higher baseline TIMP-1 levels than those without AF recurrence (129.8 ± 65.7 vs. 112.0 ± 51.0 ng/ml, P = 0.041). The same was true of high-sensitivity C-reactive protein (3.9 ± 6.0 vs. 1.9 ± 2.8 ng/ml, P = 0.001). When a TIMP-1 cutoff of 124.15 ng/ml was set, patients with TIMP-1 ≥ 124.15 ng/ml had a higher risk of recurrent AF than those with TIMP-1 < 124.15 ng/ml (HR, 1.961, 95% CI, 1.182–2. 253, P = 0.009). Multivariate Cox regression analysis revealed that high TIMP-1 was an independent risk factor for AF recurrence. Univariate Cox regression analysis found that substrate modification surgery does not affect AF recurrence (P = 0.553). Subgroup analysis revealed that female sex, age < 65 years, hypertension (HTN), body mass index (BMI) ≥ 24 kg/m2, CHA2DS2-VASc score < 2, HAS-BLED score < 3, and EHRA score = 3 combined with high TIMP-1 level would perform well at predicting AF recurrence after RFCA. Conclusion Elevated preoperative TIMP-1 levels are related to a higher risk of AF recurrence and can independently predict AF recurrence following RFCA.
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Affiliation(s)
- Haiwei Li
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Weiping Sun
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China,Beijing Institute of Heart, Lung and Blood Vessel Disease, Beijing, China,The Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing, China
| | - Zefeng Wang
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Ziyu Wang
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xiao Du
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Junjun Chen
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jianwei Gao
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China,Beijing Institute of Heart, Lung and Blood Vessel Disease, Beijing, China
| | - Xuxia Liu
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China,Beijing Institute of Heart, Lung and Blood Vessel Disease, Beijing, China,The Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing, China
| | - Xipeng Wang
- Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Yueli Wang
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yongquan Wu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China,*Correspondence: Yongquan Wu,
| | - Xiaoping Zhang
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China,Beijing Institute of Heart, Lung and Blood Vessel Disease, Beijing, China,The Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing, China,Xiaoping Zhang,
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Podzolkov VI, Tarzimanova AI, Bragina AE, Gataulin RG, Oganesyan KA, Pokrovskaya AE, Osadchy KK. The importance of matrix metalloproteinases in the development of atrial fibrillation in obesity. TERAPEVT ARKH 2022; 93:1451-1456. [DOI: 10.26442/00403660.2021.12.201178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Indexed: 11/22/2022]
Abstract
Background. One of the trends in modern cardiology is the study of the matrix metalloproteinase (MMP) system. Currently, an increase in plasma concentrations of some MMPs and their tissue inhibitors is considered as one of the earliest biochemical markers of myocardial fibrosis in various diseases of the cardiovascular system. Discusses the importance of MMP in the development of atrial fibrillation (AF).
Aim. To study the effect of the MMP system on the development of AF in obese patients.
Materials and methods. The study included 105 patients with a body mass index of more than 30 kg/m2. Depending on the presence of AF, the patients were divided into 2 groups. The criterion for inclusion of patients in group 1 was the presence of documented AF paroxysm in 55 obese patients. The comparison group (group 2) consisted of 50 obese patients without heart rhythm disorders. When patients were included in the study, in order to assess the severity of visceral obesity, all patients underwent a general clinical examination, echocardiography. To determine the activity of the MMP system, venous blood was taken from patients.
Results. Significantly higher values of MMP-9 were detected in patients with obesity and paroxysmal AF 315.753.4 ng/ml than in patients with obesity without heart rhythm disorders 220.954.7 ng/ml (p=0.002); the values of tissue inhibitor of metalloproteinase 1 were 185.342.2 and 119.242.6 ng/ml, respectively (p=0.007). In patients with obesity and paroxysmal AF, a correlation of moderate strength between the level of MMP-9 and the volume of left atrium and a direct dependence of moderate strength between the ratio of waist volume to height and the plasma values of MMP-9 was revealed. The MMP-9 index (AUC 0.92) had a high diagnostic value for determining the probability of having a paroxysmal form of AF in obese patients. With an increase in the level of MMP-9 more than 295 ng/ml, it is possible to predict the presence of paroxysmal AF in obese patients with a sensitivity of 74.5% and a specificity of 94%.
Conclusion. In patients with obesity and paroxysmal AF, a significant increase in the parameters of the MMP system (MMP-9 and tissue inhibitor of metalloproteinase 1) was revealed when compared with obese patients without heart rhythm disorders (p0.05). With an increase in MMP-9 of more than 285 ng/ml in obese patients, the appearance of AF with a sensitivity of 74.5% and a specificity of 94% can be predicted.
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Li CY, Zhang JR, Hu WN, Li SN. Atrial fibrosis underlying atrial fibrillation (Review). Int J Mol Med 2021; 47:9. [PMID: 33448312 PMCID: PMC7834953 DOI: 10.3892/ijmm.2020.4842] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 12/07/2020] [Indexed: 01/17/2023] Open
Abstract
Atrial fibrillation (AF) is one of the most common tachyarrhythmias observed in the clinic and is characterized by structural and electrical remodelling. Atrial fibrosis, an emblem of atrial structural remodelling, is a complex multifactorial and patient-specific process involved in the occurrence and maintenance of AF. Whilst there is already considerable knowledge regarding the association between AF and fibrosis, this process is extremely complex, involving intricate neurohumoral and cellular and molecular interactions, and it is not limited to the atrium. Current technological advances have made the non-invasive evaluation of fibrosis in the atria and ventricles possible, facilitating the selection of patient-specific ablation strategies and upstream treatment regimens. An improved understanding of the mechanisms and roles of fibrosis in the context of AF is of great clinical significance for the development of treatment strategies targeting the fibrous region. In the present review, a focus was placed on the atrial fibrosis underlying AF, outlining its role in the occurrence and perpetuation of AF, by reviewing recent evaluations and potential treatment strategies targeting areas of fibrosis, with the aim of providing a novel perspective on the management and prevention of AF.
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Affiliation(s)
- Chang Yi Li
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, P.R. China
| | - Jing Rui Zhang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, P.R. China
| | - Wan Ning Hu
- Department of Cardiology, Laboratory of Molecular Biology, Head and Neck Surgery, Tangshan Gongren Hospital, Tangshan, Hebei 063000, P.R. China
| | - Song Nan Li
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, P.R. China
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7
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Butts B, Goeddel LA, George DJ, Steele C, Davies JE, Wei CC, Varagic J, George JF, Ferrario CM, Melby SJ, Dell'Italia LJ. Increased Inflammation in Pericardial Fluid Persists 48 Hours After Cardiac Surgery. Circulation 2019; 136:2284-2286. [PMID: 29203568 DOI: 10.1161/circulationaha.117.029589] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Brittany Butts
- Department of Veterans Affairs Medical Center, Birmingham, AL (J.E.D., C.-C.W., L.J.D.). Department of Medicine, Division of Cardiovascular Disease (B.B., C.-C.W., L.J.D.); Division of Pulmonary, Allergy and Critical Care (C.S.); Department of Surgery, Division of Cardiothoracic Surgery (D.J.G., J.F.G.), University of Alabama at Birmingham. Department of Surgery, Wake Forest University Health Science Center, Winston-Salem, NC (J.V., C.M.F.). Department of Surgery, Division of Cardiothoracic Surgery, Washington University, Saint Louis, MO, and Saint Louis VA Medical Center (S.J.M.). Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD (L.A.G.)
| | - Lee A Goeddel
- Department of Veterans Affairs Medical Center, Birmingham, AL (J.E.D., C.-C.W., L.J.D.). Department of Medicine, Division of Cardiovascular Disease (B.B., C.-C.W., L.J.D.); Division of Pulmonary, Allergy and Critical Care (C.S.); Department of Surgery, Division of Cardiothoracic Surgery (D.J.G., J.F.G.), University of Alabama at Birmingham. Department of Surgery, Wake Forest University Health Science Center, Winston-Salem, NC (J.V., C.M.F.). Department of Surgery, Division of Cardiothoracic Surgery, Washington University, Saint Louis, MO, and Saint Louis VA Medical Center (S.J.M.). Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD (L.A.G.)
| | - David J George
- Department of Veterans Affairs Medical Center, Birmingham, AL (J.E.D., C.-C.W., L.J.D.). Department of Medicine, Division of Cardiovascular Disease (B.B., C.-C.W., L.J.D.); Division of Pulmonary, Allergy and Critical Care (C.S.); Department of Surgery, Division of Cardiothoracic Surgery (D.J.G., J.F.G.), University of Alabama at Birmingham. Department of Surgery, Wake Forest University Health Science Center, Winston-Salem, NC (J.V., C.M.F.). Department of Surgery, Division of Cardiothoracic Surgery, Washington University, Saint Louis, MO, and Saint Louis VA Medical Center (S.J.M.). Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD (L.A.G.)
| | - Chad Steele
- Department of Veterans Affairs Medical Center, Birmingham, AL (J.E.D., C.-C.W., L.J.D.). Department of Medicine, Division of Cardiovascular Disease (B.B., C.-C.W., L.J.D.); Division of Pulmonary, Allergy and Critical Care (C.S.); Department of Surgery, Division of Cardiothoracic Surgery (D.J.G., J.F.G.), University of Alabama at Birmingham. Department of Surgery, Wake Forest University Health Science Center, Winston-Salem, NC (J.V., C.M.F.). Department of Surgery, Division of Cardiothoracic Surgery, Washington University, Saint Louis, MO, and Saint Louis VA Medical Center (S.J.M.). Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD (L.A.G.)
| | - James E Davies
- Department of Veterans Affairs Medical Center, Birmingham, AL (J.E.D., C.-C.W., L.J.D.). Department of Medicine, Division of Cardiovascular Disease (B.B., C.-C.W., L.J.D.); Division of Pulmonary, Allergy and Critical Care (C.S.); Department of Surgery, Division of Cardiothoracic Surgery (D.J.G., J.F.G.), University of Alabama at Birmingham. Department of Surgery, Wake Forest University Health Science Center, Winston-Salem, NC (J.V., C.M.F.). Department of Surgery, Division of Cardiothoracic Surgery, Washington University, Saint Louis, MO, and Saint Louis VA Medical Center (S.J.M.). Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD (L.A.G.)
| | - Chih-Chang Wei
- Department of Veterans Affairs Medical Center, Birmingham, AL (J.E.D., C.-C.W., L.J.D.). Department of Medicine, Division of Cardiovascular Disease (B.B., C.-C.W., L.J.D.); Division of Pulmonary, Allergy and Critical Care (C.S.); Department of Surgery, Division of Cardiothoracic Surgery (D.J.G., J.F.G.), University of Alabama at Birmingham. Department of Surgery, Wake Forest University Health Science Center, Winston-Salem, NC (J.V., C.M.F.). Department of Surgery, Division of Cardiothoracic Surgery, Washington University, Saint Louis, MO, and Saint Louis VA Medical Center (S.J.M.). Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD (L.A.G.)
| | - Jasmina Varagic
- Department of Veterans Affairs Medical Center, Birmingham, AL (J.E.D., C.-C.W., L.J.D.). Department of Medicine, Division of Cardiovascular Disease (B.B., C.-C.W., L.J.D.); Division of Pulmonary, Allergy and Critical Care (C.S.); Department of Surgery, Division of Cardiothoracic Surgery (D.J.G., J.F.G.), University of Alabama at Birmingham. Department of Surgery, Wake Forest University Health Science Center, Winston-Salem, NC (J.V., C.M.F.). Department of Surgery, Division of Cardiothoracic Surgery, Washington University, Saint Louis, MO, and Saint Louis VA Medical Center (S.J.M.). Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD (L.A.G.)
| | - James F George
- Department of Veterans Affairs Medical Center, Birmingham, AL (J.E.D., C.-C.W., L.J.D.). Department of Medicine, Division of Cardiovascular Disease (B.B., C.-C.W., L.J.D.); Division of Pulmonary, Allergy and Critical Care (C.S.); Department of Surgery, Division of Cardiothoracic Surgery (D.J.G., J.F.G.), University of Alabama at Birmingham. Department of Surgery, Wake Forest University Health Science Center, Winston-Salem, NC (J.V., C.M.F.). Department of Surgery, Division of Cardiothoracic Surgery, Washington University, Saint Louis, MO, and Saint Louis VA Medical Center (S.J.M.). Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD (L.A.G.)
| | - Carlos M Ferrario
- Department of Veterans Affairs Medical Center, Birmingham, AL (J.E.D., C.-C.W., L.J.D.). Department of Medicine, Division of Cardiovascular Disease (B.B., C.-C.W., L.J.D.); Division of Pulmonary, Allergy and Critical Care (C.S.); Department of Surgery, Division of Cardiothoracic Surgery (D.J.G., J.F.G.), University of Alabama at Birmingham. Department of Surgery, Wake Forest University Health Science Center, Winston-Salem, NC (J.V., C.M.F.). Department of Surgery, Division of Cardiothoracic Surgery, Washington University, Saint Louis, MO, and Saint Louis VA Medical Center (S.J.M.). Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD (L.A.G.)
| | - Spencer J Melby
- Department of Veterans Affairs Medical Center, Birmingham, AL (J.E.D., C.-C.W., L.J.D.). Department of Medicine, Division of Cardiovascular Disease (B.B., C.-C.W., L.J.D.); Division of Pulmonary, Allergy and Critical Care (C.S.); Department of Surgery, Division of Cardiothoracic Surgery (D.J.G., J.F.G.), University of Alabama at Birmingham. Department of Surgery, Wake Forest University Health Science Center, Winston-Salem, NC (J.V., C.M.F.). Department of Surgery, Division of Cardiothoracic Surgery, Washington University, Saint Louis, MO, and Saint Louis VA Medical Center (S.J.M.). Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD (L.A.G.)
| | - Louis J Dell'Italia
- Department of Veterans Affairs Medical Center, Birmingham, AL (J.E.D., C.-C.W., L.J.D.). Department of Medicine, Division of Cardiovascular Disease (B.B., C.-C.W., L.J.D.); Division of Pulmonary, Allergy and Critical Care (C.S.); Department of Surgery, Division of Cardiothoracic Surgery (D.J.G., J.F.G.), University of Alabama at Birmingham. Department of Surgery, Wake Forest University Health Science Center, Winston-Salem, NC (J.V., C.M.F.). Department of Surgery, Division of Cardiothoracic Surgery, Washington University, Saint Louis, MO, and Saint Louis VA Medical Center (S.J.M.). Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD (L.A.G.).
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8
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Bening C, Mazalu EA, Yaqub J, Alhussini K, Glanowski M, Kottmann T, Leyh R. Atrial contractility and fibrotic biomarkers are associated with atrial fibrillation after elective coronary artery bypass grafting. J Thorac Cardiovasc Surg 2019; 159:515-523. [PMID: 30929988 DOI: 10.1016/j.jtcvs.2019.02.068] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 02/14/2019] [Accepted: 02/15/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVE New-onset postoperative atrial fibrillation is common after cardiac surgery. Less has been reported about the relationship among fibrosis, inflammation, calcium-induced left atrial and right atrial contractile forces, and postoperative atrial fibrillation. We sought to identify predictors of postoperative atrial fibrillation. METHODS From August 2016 to February 2018, we evaluated 229 patients who had preoperative sinus rhythm before elective primary coronary artery bypass grafting. Of 229 patients, 191 maintained sinus rhythm postoperatively, whereas 38 patients developed atrial fibrillation. Preoperative tissue inhibitor of metalloproteinase-1, pentraxin-3, matrix metallopeptidase-9, galectin-3, high-sensitivity C-reactive protein, growth differentiation factor 15, and transforming growth factor-ß were measured. Clinical and echocardiographic findings (tricuspid annular plane systolic excursion for right heart function) and calcium-induced force measurements from left atrial and right atrial-derived skinned myocardial fibers were recorded. RESULTS Patients with atrial fibrillation were older (P = .001), had enlarged left atrial (P = .0001) and right atrial areas (P = .0001), and had decreased tricuspid annular plane systolic excursion (P = .001). Levels of matrix metallopeptidase-9 and pentraxin-3 were decreased (P < .05), whereas growth differentiation factor 15 was increased (P = .001). We detected lower left atrial force values at calcium-induced force measurements 5.5 (P < .05), 5.4 (P < .01), and 5.3 to 4.52 (P = .0001) and right atrial force values at calcium-induced force measurements 5.0 to 4.52 (P < .05) in patients with postoperative atrial fibrillation. Multivariable analysis showed that advanced age (P = .033), decreased left atrial force value at calcium-induced force measurement of 5.5 (P = .033), enlarged left atrial (P = .013) and right atrial (P = .081) areas, and reduced tricuspid annular plane systolic excursion (P = .010) independently predicted postoperative atrial fibrillation. CONCLUSIONS Advanced age, decreased left atrial force value at calcium-induced force measurement of 5.5, enlarged left atrial and right atrial areas, and reduced tricuspid annular plane systolic excursion were identified as independent predictors for postoperative atrial fibrillation.
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Affiliation(s)
- Constanze Bening
- Department of Thoracic and Cardiovascular Surgery, University of Wuerzburg, Wuerzburg, Germany; Comprehensive Heart Failure Centre Würzburg, University of Wuerzburg, Wuerzburg, Germany.
| | - Elena-Aura Mazalu
- Department of Thoracic and Cardiovascular Surgery, University of Wuerzburg, Wuerzburg, Germany
| | - Jonathan Yaqub
- Department of Thoracic and Cardiovascular Surgery, University of Wuerzburg, Wuerzburg, Germany
| | - Khaled Alhussini
- Department of Thoracic and Cardiovascular Surgery, University of Wuerzburg, Wuerzburg, Germany
| | - Michal Glanowski
- Department of Thoracic and Cardiovascular Surgery, University of Wuerzburg, Wuerzburg, Germany
| | | | - Rainer Leyh
- Department of Thoracic and Cardiovascular Surgery, University of Wuerzburg, Wuerzburg, Germany; Comprehensive Heart Failure Centre Würzburg, University of Wuerzburg, Wuerzburg, Germany
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Wang W, Zhang K, Li X, Ma Z, Zhang Y, Yuan M, Suo Y, Liang X, Tse G, Goudis CA, Liu T, Li G. Doxycycline attenuates chronic intermittent hypoxia-induced atrial fibrosis in rats. Cardiovasc Ther 2018; 36:e12321. [PMID: 29380561 DOI: 10.1111/1755-5922.12321] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 01/06/2018] [Accepted: 01/23/2018] [Indexed: 12/22/2022] Open
Affiliation(s)
- Weiding Wang
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease; Department of Cardiology; Tianjin Institute of Cardiology; Second Hospital of Tianjin Medical University; Tianjin China
| | - Kai Zhang
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease; Department of Cardiology; Tianjin Institute of Cardiology; Second Hospital of Tianjin Medical University; Tianjin China
| | - Xiongfeng Li
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease; Department of Cardiology; Tianjin Institute of Cardiology; Second Hospital of Tianjin Medical University; Tianjin China
| | - Zuowang Ma
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease; Department of Cardiology; Tianjin Institute of Cardiology; Second Hospital of Tianjin Medical University; Tianjin China
| | - Yue Zhang
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease; Department of Cardiology; Tianjin Institute of Cardiology; Second Hospital of Tianjin Medical University; Tianjin China
| | - Meng Yuan
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease; Department of Cardiology; Tianjin Institute of Cardiology; Second Hospital of Tianjin Medical University; Tianjin China
| | - Ya Suo
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease; Department of Cardiology; Tianjin Institute of Cardiology; Second Hospital of Tianjin Medical University; Tianjin China
| | - Xue Liang
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease; Department of Cardiology; Tianjin Institute of Cardiology; Second Hospital of Tianjin Medical University; Tianjin China
| | - Gary Tse
- Department of Medicine and Therapeutics; Chinese University of Hong Kong; Hong Kong China
- Li Ka Shing Institute of Health Sciences; Faculty of Medicine; Chinese University of Hong Kong; Hong Kong China
| | | | - Tong Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease; Department of Cardiology; Tianjin Institute of Cardiology; Second Hospital of Tianjin Medical University; Tianjin China
| | - Guangping Li
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease; Department of Cardiology; Tianjin Institute of Cardiology; Second Hospital of Tianjin Medical University; Tianjin China
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Chen P, Chen J, Xie X, Zhu J, Xia L. Eosinophils in patients with lone atrial fibrillation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2017. [PMID: 28639752 DOI: 10.1111/pace.13146] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Inflammation has been evidenced as a critical contributable mechanism for the atrial fibrillation (AF) onset and development. As the consistent inflammatory and oxidative marker, the effects of white blood cell (WBC) and its differential on lone atrial fibrillation (LAF) were investigated in the study. METHODS A total of 126 patients with paroxysmal LAF who scheduled for rhythm control drug therapy and 120 age- and gender-matched subjects in sinus rhythm were included sequentially. Peripheral blood sample and clinic data were collected during the first evaluation. Recurrence of AF was evaluated by outpatient clinics and telephone visits for the following 12 months. RESULTS Peripheral eosinophil count, neutrophil count, and left atrial diameter (LAD) were significantly higher in LAF than control. Within a follow-up of 12 months, 56 patients (44.4%) had developed AF recurrence. Patients with AF recurrence had higher eosinophil count and LAD. Univariable analyses showed a statistically significant relationship between eosinophil count (P = 0.042), LAD (P = 0.030), and AF recurrence. Multivariate logistic regression analysis showed that LAD (OR: 1.090 per 1 mm increase; 95% CI: 1.007-1.180; P = 0.032) and eosinophil (OR: 1.643 per 1 × 108 /L increase; 95% CI: 1.047-2.578; P = 0.031) were independent predictors of AF recurrence during antiarrhythmic drug therapy. CONCLUSION Our results support the association of the WBC response and its components with the LAF. Especially, the peripheral eosinophil and LAD may play important roles in mediating inflammation and atrial remodeling in AF.
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Affiliation(s)
- Peng Chen
- Department of Cardiology, the Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Junzhu Chen
- Department of Cardiology, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Xudong Xie
- Department of Cardiology, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Junhui Zhu
- Department of Cardiology, Biomedical Research (Therapy) Center, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Liang Xia
- Department of Cardiology, Biomedical Research (Therapy) Center, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
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Affiliation(s)
- Uğur Canpolat
- Hacettepe University Faculty of Medicine, Department of Cardiology, Ankara, Turkey
- E-mail:
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