Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, 66421 Homburg/Saar, Germany.
Clin Res Cardiol. 2012 Aug;101(8):655-61. doi: 10.1007/s00392-012-0440-6. Epub 2012 Mar 10.
Atrial fibrosis and its spatial heterogeneity are regarded as a substrate for the perpetuation of atrial arrhythmias. During collagen synthesis and degradation, collagen propeptides and telopeptides are released into the blood. This study tested the hypothesis that serum markers of collagen turnover correlate with atrial fibrosis.
We prospectively included 28 patients in sinus rhythm undergoing cardiac surgery. Plasma concentrations of the carboxy- and amino-terminal propeptide of procollagen type-I (PICP and PINP) and type-III (PIIINP), and the C-terminal telopeptide of type-I collagen (ICTP) were determined. Interstitial fibrosis of left (n = 10) and right atrial appendages (n = 28) was analyzed histologically.
We found a correlation between left and right atrial fibrosis (r (s) = 0.79, p < 0.01). Interestingly, the higher the interstitial collagen content, the higher was the spatial heterogeneity of fibrosis (r (s) = 0.90, p < 0.001). However, PICP, PIIINP, and ICTP were not correlated to left or right atrial collagen content, or to the spatial heterogeneity of atrial fibrosis. There was a weak and even negative correlation between the serum PINP concentration and the degree of fibrosis in both the left and the right atrium (r (s) = -0.65 (p = 0.04) and r (s) = -0.42 (p = 0.03), respectively).
A high degree of interstitial atrial fibrosis indicates a high degree of spatial heterogeneity of interstitial collagen. Although serum PICP is known to be correlated with ventricular fibrosis, this and other serum markers of collagen turnover (PINP, PIIINP, and ICTP) do not directly reflect atrial fibrosis in patients with severe cardiac disease.
心房纤维化及其空间异质性被认为是维持心房性心律失常的基质。在胶原合成和降解过程中，胶原前肽和末端肽被释放到血液中。本研究旨在检验胶原转换血清标志物与心房纤维化相关的假说。
我们前瞻性纳入 28 例窦性心律行心脏手术的患者。测定血浆Ⅰ型前胶原羧基端肽（PICP）和氨基端前肽（PINP）、Ⅲ型前胶原氨基端肽（PIIINP）和Ⅰ型胶原 C 端末端肽（ICTP）的浓度。分析左、右心耳（n=10、28）的间质纤维化程度。
我们发现左、右心房纤维化之间存在相关性（r(s)=0.79，p<0.01）。有趣的是，胶原含量越高，纤维化的空间异质性越高（r(s)=0.90，p<0.001）。然而，PICP、PIIINP 和 ICTP 与左、右心房胶原含量或心房纤维化的空间异质性均无相关性。血清 PINP 浓度与左、右心房纤维化程度之间存在弱相关，甚至呈负相关（r(s)=-0.65（p=0.04）和 r(s)=-0.42（p=0.03））。
间质纤维化程度越高，间质胶原的空间异质性越高。虽然血清 PICP 与心室纤维化相关，但本研究及其他胶原转换的血清标志物（PINP、PIIINP 和 ICTP）并不能直接反映严重心脏疾病患者的心房纤维化程度。
