Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong, China.
PLoS One. 2012;7(12):e52125. doi: 10.1371/journal.pone.0052125. Epub 2012 Dec 20.
Inflammatory cytokines, cardiomyocyte apoptosis, and altered collagen turnover may contribute to unfavourable ventricular remodeling. This unfavourable ventricular remodelling is well documented in patients after atrial switch operation for complete transposition of the great arteries. We therefore tested if levels of circulating markers of inflammation, apoptosis, collagen synthesis, and extracellular matrix degradation are altered in patients after atrial switch operation for transposition of the great arteries.
Circulating tumour necrosis factor (TNF)-α, annexin A5 (AnxA5), carboxy-terminal propeptide of type I procollagen (PICP), amino-terminal propeptide of type III procollagen (PIIINP), matrix metalloproteinase-1 (MMP-1), and tissue inhibitor of metalloproteinase-1 (TIMP-1) levels were determined in 27 patients aged 25.2±3.1 years and 20 controls. Ventricular myocardial deformation and left ventricular eccentricity index (EI) were determined by speckle tracking and two-dimensional echocardiography, respectively. Compared with controls, patients had significantly higher circulating AnxA5 (p<0.001) and TNF-α (p = 0.018) levels, but similar PICP, PIIINP, MMP-1 and TIMP-1 levels. For the whole cohort, plasma AnxA5 correlated with serum TNF-α (p = 0.002), systemic ventricular global longitudinal strain (GLS) and systolic and early diastolic strain rate (all p<0.001), and subpulmonary ventricular GLS and early diastolic strain rate (both p<0.001). In patients, plasma AnxA5 level correlated positively with subpulmonary ventricular EI (p = 0.027). Multiple linear regression analysis identified systemic ventricular GLS (β = -0.50, p<0.001) and serum TNF-α (β = 0.29, p = 0.022) as significant correlates of plasma AnxA5.
Elevated plasma AnxA5 level in patients after atrial switch operation is associated with impaired systemic myocardial deformation, increased subpulmonary ventricular eccentricity, and increased serum TNF-α level.
炎症细胞因子、心肌细胞凋亡和胶原蛋白代谢改变可能导致心室重构不良。完全性大动脉转位患者行心房调转术后，这种不良的心室重构已得到充分证实。因此，我们检测了大动脉转位患者行心房调转术后循环中炎症、凋亡、胶原蛋白合成和细胞外基质降解标志物的水平是否发生改变。
我们测定了 27 例年龄为 25.2±3.1 岁的患者和 20 例对照者的循环肿瘤坏死因子（TNF）-α、膜联蛋白 A5（AnxA5）、Ⅰ型前胶原羧基末端前肽（PICP）、Ⅲ型前胶原氨基末端前肽（PIIINP）、基质金属蛋白酶-1（MMP-1）和组织金属蛋白酶抑制剂-1（TIMP-1）水平。应用斑点追踪和二维超声心动图分别测定心室心肌变形和左心室偏心指数（EI）。与对照组相比，患者的循环 AnxA5（p<0.001）和 TNF-α（p=0.018）水平显著升高，而 PICP、PIIINP、MMP-1 和 TIMP-1 水平无差异。对于整个队列，血浆 AnxA5 与血清 TNF-α（p=0.002）、整体左心室纵向应变（GLS）和收缩期及舒张早期应变率（均 p<0.001）以及肺动脉瓣下左心室 GLS 和舒张早期应变率（均 p<0.001）相关。患者中，血浆 AnxA5 水平与肺动脉瓣下左心室 EI 呈正相关（p=0.027）。多元线性回归分析发现，整体左心室 GLS（β=-0.50，p<0.001）和血清 TNF-α（β=0.29，p=0.022）是血浆 AnxA5 的显著相关因素。
心房调转术后患者血浆 AnxA5 水平升高与系统性心肌变形受损、肺动脉瓣下左心室偏心度增加和血清 TNF-α水平升高相关。
