Facultad de Medicina, Pontificia Universidad Catolica de Chile, Chile.
Int J Cardiol. 2011 Aug 4;150(3):270-6. doi: 10.1016/j.ijcard.2010.04.033. Epub 2010 May 5.
Post-operative atrial fibrillation occurs in 30% of patients after on-pump heart surgery and is associated to elevated inflammatory markers. We have evaluated if the systemic biomarkers of inflammation and endothelial damage, vascular cell adhesion molecule-1 (VCAM-1) and soluble thrombomodulin may help in identifying patients prone to development of post-operative atrial fibrillation.
One hundred and forty-four patients in sinus rhythm submitted to elective coronary artery bypass surgery. Systemic inflammatory, oxidative stress and endothelial damage markers were measured at baseline and 72 h after surgery. During the procedure, a sample of the right atrial appendage was obtained for histochemistry. Electrocardiogram was monitored for 72 h after surgery for event adjudication.
22% of the patients developed post-operative atrial fibrillation. Baseline systemic inflammatory markers did not differ between patients with or without post-operative atrial fibrillation. However, baseline plasma VCAM-1 and thrombomodulin levels were significantly higher in patients who developed post-operative atrial fibrillation. After adjustment for age, gender, comorbidities and concurrent medication, circulating VCAM-1 remained as an independent predictor for post-operative atrial fibrillation development. No association was observed between systemic plasma VCAM-1 and VCAM-1 tissue expression in the right atrial appendage.
In patients undergoing coronary artery bypass surgery, elevated VCAM-1 levels predict a higher risk for post-operative atrial fibrillation. Plasma VCAM-1 elevation is not related to its expression in the right atria, suggesting that systemic endothelial damage rather than local changes pre-exist in patients who develop the arrhythmia.
体外循环心脏手术后 30%的患者会发生术后心房颤动，且与炎症标志物升高有关。我们评估了全身炎症和内皮损伤的生物标志物，血管细胞黏附分子-1（VCAM-1）和可溶性血栓调节蛋白，是否有助于识别易发生术后心房颤动的患者。
144 例窦性节律患者接受择期冠状动脉旁路移植术。在基线和手术后 72 小时测量全身炎症、氧化应激和内皮损伤标志物。在手术过程中，获取右心耳样本进行组织化学检查。术后 72 小时监测心电图以确定事件。
22%的患者发生术后心房颤动。术后心房颤动患者的基线全身炎症标志物与无术后心房颤动患者无差异。然而，发生术后心房颤动的患者基线血浆 VCAM-1 和血栓调节蛋白水平明显升高。调整年龄、性别、合并症和同时使用的药物后，循环 VCAM-1 仍然是术后心房颤动发生的独立预测因子。全身血浆 VCAM-1 与右心耳组织 VCAM-1 表达之间无相关性。
在接受冠状动脉旁路移植术的患者中，升高的 VCAM-1 水平预示着术后心房颤动的风险更高。血浆 VCAM-1 升高与其在右心房的表达无关，提示发生心律失常的患者存在全身性内皮损伤，而不是局部变化。
