Haemostasis, Thrombosis, and Vascular Biology Unit, Department of Medicine, University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, UK.
Thromb Haemost. 2010 Jul;104(1):122-7. doi: 10.1160/TH09-12-0837. Epub 2010 May 10.
Atrial fibrillation (AF) is a common complication of coronary artery bypass grafting (CABG). We sought to determine the diagnostic validity of plasma biomarkers of i) inflammation (marked by interleukin-6 [IL-6] and high-sensitivity C-reactive protein [hs-CRP]), ii) extracellular matrix remodelling (matrix metalloproteinase [MMP-9], tissue inhibitor of matrix metalloproteinase [TIMP-1]) and iii) the prothrombotic state (tissue factor and von Willebrand factor [vWF]) in the risk prediction of post-operative AF. Samples were obtained preoperatively from peripheral/femoral vein and from intracardiac chambers (right atrium [RA], the right atrial appendage [RAA], the left atrium [LA] and the left atrial appendage [LAA]) amongst 100 consecutive patients free of AF and inflammatory disease undergoing elective CABG. Biomarker concentrations were related to incident AF (30 days). At 30 days post CABG, 30 patients were proven to have had AF. Concentrations of tissue factor (TF) and vWF were unrelated to postoperative AF. Peripheral (p=0.018), and intracardiac levels (RAA (p=0.029) and LA (p=0.026)) of hs-CRP were associated with the presence of AF after CABG. Intracardiac levels of IL-6 in samples from the RAA (p=0.031), LA (p=0.042) and LAA (p=0.006), and MMP-9 in the LAA sample were also associated with AF (p=0.007). Our data suggest that an intra-cardiac inflammatory environment that is manifest peri-operatively may predispose to the development of post-operative AF. This intracardiac inflammatory state was reflected by increased peripheral hs-CRP levels. These differences may indicate local substrate abnormalities contributing to the development of AF post-operatively.
心房颤动（AF）是冠状动脉旁路移植术（CABG）的常见并发症。我们旨在确定血浆生物标志物 i）炎症（由白细胞介素-6 [IL-6]和高敏 C 反应蛋白 [hs-CRP] 标记），ii）细胞外基质重塑（基质金属蛋白酶 [MMP-9]，基质金属蛋白酶抑制剂 [TIMP-1]）和 iii）促血栓状态（组织因子和血管性血友病因子 [vWF]）在预测术后 AF 中的诊断准确性。在 100 例无 AF 和炎症性疾病的连续患者中，在接受择期 CABG 手术前，从外周/股静脉和心内腔（右心房 [RA]、右心房附件 [RAA]、左心房 [LA]和左心房附件 [LAA]）中获得了样本。在接受 CABG 后 30 天，有 30 例患者被证实患有 AF。组织因子（TF）和 vWF 的浓度与术后 AF 无关。外周 hs-CRP 水平（p=0.018）和心内 hs-CRP 水平（RAA（p=0.029）和 LA（p=0.026））与 CABG 后 AF 的存在相关。来自 RAA（p=0.031）、LA（p=0.042）和 LAA（p=0.006）的 RAA 样本中的 IL-6 以及 LAA 样本中的 MMP-9 的心内水平也与 AF 相关（p=0.007）。我们的数据表明，围手术期表现出的心脏内炎症环境可能使术后 AF 的发生倾向增加。这种心脏内炎症状态反映在外周 hs-CRP 水平升高。这些差异可能表明局部底物异常有助于术后 AF 的发展。
