Department of Cardiothoracic Surgery, St George's Hospital, Blackshaw Road, London SW17 0QT, UK.
Eur J Cardiothorac Surg. 2011 Feb;39(2):228-32. doi: 10.1016/j.ejcts.2010.05.006. Epub 2010 Jul 6.
Inflammation has been implicated in the pathogenesis of postoperative atrial fibrillation (AF). Adipose tissue secretes both pro-inflammatory cytokines such as interleukin-6 (IL-6) and anti-inflammatory mediators such as adiponectin. We set out to examine the association of adiponectin and IL-6, both circulating and locally produced by the epicardial adipose tissue, with AF development after cardiac surgery.
A total of 90 consecutive patients undergoing cardiac surgery were evaluated. Blood samples were collected before induction of anaesthesia. Epicardial fat was obtained upon commencement of cardiopulmonary bypass. IL-6 and adiponectin levels were determined in serum and supernatant of epicardial adipose tissue organ cultures with two-site enzyme-linked immunosorbent assay (ELISA). Heart rhythm was assessed with continuous tele-monitoring for 72 h postoperatively, and with 6-hourly clinical examinations and daily electrocardiograms (ECGs) thereafter.
A total of 36 patients developed postoperative AF (40%). Baseline-serum IL-6 and adiponectin were not associated with AF (p = 0.86 and 0.95, respectively). Epicardial adipose tissue IL-6 levels did not correlate with the development of the arrhythmia either (p = 0.37). However, epicardial adiponectin release was lower in patients who developed AF than in those who remained in sinus rhythm (76 (interquartile range (IQR) 35-98) vs 53 ((IQR) 35-69) ng h(-1)g(-1) of tissue cultured, p = 0.066). Following linear regression, the association of epicardial adiponectin with AF almost reached statistical significance (p = 0.066). Multivariate logistic regression analysis of identified risk factors for AF, with the inclusion of epicardial adiponectin as an independent variable, revealed increased age (odds ratio (OR) 1.09, 95% confidence interval (CI) 1.02-1.17, p = 0.013) and epicardial adiponectin levels (OR 0.98, 95% CI 0.97-1.00, p = 0.054) as independent predictors of postoperative AF.
Increased epicardial adiponectin is associated with maintenance of sinus rhythm following cardiac surgery. This reinforces the inflammatory hypothesis in the pathogenesis of postoperative AF and may represent a novel therapeutic target for its effective prevention.
炎症与心脏手术后心房颤动（AF）的发病机制有关。脂肪组织既能分泌白细胞介素-6（IL-6）等促炎细胞因子，也能分泌脂联素等抗炎介质。我们旨在研究循环和心外膜脂肪组织局部产生的脂联素和 IL-6 与心脏手术后 AF 发展之间的关系。
连续评估 90 例接受心脏手术的患者。在麻醉诱导前采集血样。在体外循环开始时获得心外膜脂肪。采用双位点酶联免疫吸附试验（ELISA）测定血清和心外膜脂肪组织器官培养上清液中的 IL-6 和脂联素水平。术后连续 72 小时进行心电遥测监测心律，术后 6 小时临床检查和每天心电图（ECG）。
共有 36 例患者发生术后 AF（40%）。基线血清 IL-6 和脂联素与 AF 无关（p = 0.86 和 0.95）。心外膜脂肪组织 IL-6 水平与心律失常的发生也没有相关性（p = 0.37）。然而，发生 AF 的患者心外膜脂肪组织释放的脂联素低于窦性心律患者（76（四分位距（IQR）35-98）与 53（IQR）35-69）ng h(-1)g(-1)组织培养，p = 0.066）。经线性回归分析，心外膜脂联素与 AF 的相关性几乎具有统计学意义（p = 0.066）。对 AF 的识别危险因素进行多元逻辑回归分析，将心外膜脂联素作为一个独立变量，结果显示年龄增长（优势比（OR）1.09，95%置信区间（CI）1.02-1.17，p = 0.013）和心外膜脂联素水平（OR 0.98，95%CI 0.97-1.00，p = 0.054）是术后 AF 的独立预测因素。
心外膜脂联素增加与心脏手术后维持窦性心律有关。这进一步证实了炎症在心脏手术后 AF 发病机制中的作用，并可能成为其有效预防的新治疗靶点。
