Müller Patrick, Deneke Thomas, Schiedat Fabian, Bösche Leif, Strauch Justus, Dietrich Johannes Wolfgang, Vogt Markus, Tannapfel Andrea, Stiegler Hugo, Mügge Andreas, Ewers Aydan
Division of Cardiology & Angiology.
J Cardiovasc Electrophysiol. 2013 Oct;24(10):1110-5. doi: 10.1111/jce.12191. Epub 2013 Jun 21.
We evaluated if preoperative serum apoptosis markers correlate with atrial histological remodeling and postoperative atrial fibrillation (POAF) after cardiac surgery.
A total of 33 patients with sinus rhythm (SR) and without history of atrial fibrillation (AF) undergoing cardiac surgery were prospectively enrolled. Serum concentrations of Fas (apoptosis-stimulating fragment ligand) and TRAIL (tumor necrosis factor-related apoptosis-inducing ligand) were measured preoperatively. Right atrial appendage (RAA) tissue was obtained during surgery. Atrial apoptosis was assessed via TUNEL assay and degree of atrial fibrosis was categorized histologically by visual quantification. Continuous ECG-Monitoring was used to screen for POAF throughout 10 days after cardiac surgery. POAF occurred in 15 patients (45%). Atrial apoptosis was higher in patients with POAF as compared to those without (35.9 ± 9.8% vs 14.5 ± 7.5%; P < 0.0001) and correlated with the degree of atrial fibrosis (r = 0.69; P < 0.0001). In contrast to TRAIL (87.0 ± 8.2 pg/mL vs 83.3 ± 9.4 pg/mL; P = 0.77), preoperative Fas serum concentration was significantly higher in patients with POAF compared to patients in stable SR (91.3 ± 7.2 pg/mL vs 66.7 ± 3.0 pg/mL; P < 0.01). Serum Fas concentration correlated with the degree of atrial apoptosis (r = 0.63; P < 0.001) and the degree of atrial fibrosis (r = 0.39; P < 0.05).
Preoperative evaluation of serum apoptosis marker Fas is useful to identify patients at risk for POAF undergoing cardiac surgery. Fas but not TRAIL correlates with the documented degree of atrial apoptosis and atrial fibrosis in RAA tissue. Further studies need to identify the prospective role of Fas in predicting POAF events.
我们评估了术前血清凋亡标志物是否与心脏手术后的心房组织重塑及术后房颤（POAF）相关。
前瞻性纳入33例接受心脏手术且无房颤病史的窦性心律（SR）患者。术前测定血清Fas（凋亡刺激片段配体）和TRAIL（肿瘤坏死因子相关凋亡诱导配体）浓度。手术中获取右心耳（RAA）组织。通过TUNEL法评估心房凋亡情况，并通过视觉量化对心房纤维化程度进行组织学分类。术后10天内采用连续心电图监测筛查POAF。15例患者（45%）发生POAF。与未发生POAF的患者相比，发生POAF的患者心房凋亡更高（35.9±9.8%对14.5±7.5%；P<0.0001），且与心房纤维化程度相关（r=0.69；P<0.0001）。与TRAIL不同（87.0±8.2 pg/mL对83.3±9.4 pg/mL；P=0.77），发生POAF的患者术前血清Fas浓度显著高于窦性心律稳定的患者（91.3±7.2 pg/mL对66.7±3.0 pg/mL；P<0.01）。血清Fas浓度与心房凋亡程度相关（r=0.63；P<0.001），也与心房纤维化程度相关（r=0.39；P<0.05）。
术前评估血清凋亡标志物Fas有助于识别接受心脏手术有发生POAF风险的患者。Fas而非TRAIL与RAA组织中记录的心房凋亡程度和心房纤维化程度相关。需要进一步研究确定Fas在预测POAF事件中的前瞻性作用。
