Division of Cardiothoracic Surgery, Medical University of South Carolina, 770 MUSC Complex, Suite 326, Charleston, SC 29425, USA.
J Cardiovasc Transl Res. 2013 Aug;6(4):528-35. doi: 10.1007/s12265-013-9471-2. Epub 2013 May 31.
Atrial fibrosis is considered to contribute to atrial fibrillation (AF) recurrence following cardioversion. This study tested the hypothesis that circulating levels of matrix metalloproteinases (MMPs) and tissue inhibitors of MMPs (TIMPs) can predict AF recurrence postcardioversion. Precardioversion plasma samples (n = 82) were assayed for MMPs (eight types), TIMPs (all four types), N-terminus pro B-type natriuretic peptide, and high-sensitivity C-reactive protein levels. Patients were followed for AF recurrence postcardioversion. Despite 100 % restoration of sinus rhythm, 36 (44 %) reverted to AF within 3 months. Left atrial volume was increased in patients in whom AF recurred. Precardioversion MMP-9 was higher and TIMP-4 lower with AF recurrence. MMP-9, MMP-3, and TIMP-4 independently predicted AF recurrence. In multivariate analysis, combination of MMP-9, MMP-3, and TIMP-4 increased prediction of AF recurrence. Circulating levels of MMPs and TIMPs predict AF recurrence postcardioversion and may be used in a novel biomarker panel to guide AF stratification and therapy.
心房纤维化被认为是导致电复律后心房颤动（AF）复发的原因。本研究检验了以下假设，即循环中基质金属蛋白酶（MMPs）和基质金属蛋白酶抑制剂（TIMPs）的水平可以预测电复律后的 AF 复发。在电复律前采集血浆样本（n = 82），用于检测 MMP（8 种类型）、TIMP（所有 4 种类型）、N 末端 pro B 型利钠肽和高敏 C 反应蛋白水平。对患者进行电复律后 AF 复发的随访。尽管窦性心律恢复率达到 100%，但仍有 36 例（44%）在 3 个月内复发 AF。AF 复发患者的左心房容积增加。与 AF 复发相关的 MMP-9 在电复律前更高，而 TIMP-4 更低。MMP-9、MMP-3 和 TIMP-4 可独立预测 AF 复发。在多变量分析中，MMP-9、MMP-3 和 TIMP-4 的组合增加了对 AF 复发的预测。循环 MMPs 和 TIMPs 的水平可预测电复律后 AF 的复发，并且可能用于新的生物标志物组合，以指导 AF 的分层和治疗。
