Roşianu Ştefan Horia, Roşianu Adela-Nicoleta, Aldica Mihai, Căpâlneanu Radu, Buzoianu Anca Dana
Department of Cardiology, Heart Institute "Niculae Stancioiu", Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.
Heart Institute "Niculae Stancioiu", Cluj-Napoca, Romania.
Clujul Med. 2013;86(3):217-21. Epub 2013 Aug 5.
Experimental and clinical studies have shown the importance of inflammation in the pathophysiology of atrial fibrillation (AF). The renin-angiotensin-aldosterone system (RAAS) may play an important role in the pathogenesis of AF in correlation with the inflammatory process. RAAS inhibition may have important therapeutic value in limiting AF. The aim of this study was the correlation between inflammatory markers and recurrent episodes of AF in patients with known paroxysmal atrial fibrillation, with and without treatment with RAAS inhibitors.
We studied 82 patients with paroxysmal AF recorded at "Niculae Stancioiu" Heart Institute Cluj-Napoca, divided into two groups: group A treated with angiotensin converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARB) and group B without this medication. All patients underwent clinical examination, ECG, echocardiography and determination of plasma levels of inflammatory markers represented by high sensitivity C-reactive protein (hs-CRP) and interleukin 6 (IL-6). In the group treated with ACE inhibitors/ARBs, AF burden was significantly lower than in patients without treatment. We obtained a strong positive correlation between blood levels of high-sensitivity CRP and those of IL-6 (r=0.64, p<0.001), the number of yearly AF episodes (r=0.570, p<0.001), LA diameter (r=0.5, p<0.001) and LA volume (r=0.5, p<0.001). We found moderate positive correlations between blood levels of IL-6 and LA diameter (r=0.305, p=0.01), LA volume (r=0.314, p=0.01), the number of yearly AF episodes (r=0.489, p<0.001), the total number of AF episodes (r=0.304, p<0.001), BMI (r=0.473, p<0.001), LA area (r=0.458, p<0.001), LA area index (r=0.334, p=0.007) and LA volume index (r=0.304, p=0.01). The number of yearly AF episodes and BMI values influenced IL-6 blood levels (t=3.46, p=0.001, respectively t=2.17, p=0.03).
Inflammation is present in patients with AF, with or without treatment with RAAS inhibitors and is correlated with longer duration of AF, left atrial diameter and left atrial volume. ACE inhibitors and ARBs, acting on cardiac substrate and reducing the inflammatory process, may have a therapeutic protective role of decreasing AF burden.
实验和临床研究表明炎症在心房颤动（AF）的病理生理学中具有重要意义。肾素-血管紧张素-醛固酮系统（RAAS）可能在与炎症过程相关的AF发病机制中发挥重要作用。RAAS抑制在限制AF方面可能具有重要的治疗价值。本研究的目的是探讨已知阵发性心房颤动患者在使用或未使用RAAS抑制剂治疗的情况下，炎症标志物与AF复发发作之间的相关性。
我们研究了“尼古拉·斯坦乔尤”克卢日-纳波卡心脏病研究所记录的82例阵发性AF患者，分为两组：A组接受血管紧张素转换酶（ACE）抑制剂或血管紧张素受体阻滞剂（ARB）治疗，B组未接受此类药物治疗。所有患者均接受临床检查、心电图、超声心动图检查，并测定以高敏C反应蛋白（hs-CRP）和白细胞介素6（IL-6）为代表的血浆炎症标志物水平。在接受ACE抑制剂/ARB治疗的组中，AF负荷明显低于未治疗的患者。我们发现高敏CRP血水平与IL-6血水平之间存在强正相关（r = 0.64，p < 0.001），与每年AF发作次数（r = 0.570，p < 0.001）、左心房直径（r = 0.5，p < 0.001）和左心房容积（r = 0.5，p < 0.001）之间也存在强正相关。我们发现IL-6血水平与左心房直径（r = 0.305，p = 0.01）、左心房容积（r = 0.314，p = 0.01）、每年AF发作次数（r = 0.489，p < 0.001）、AF发作总数（r = 0.304，p < 0.001）、体重指数（BMI）（r = 0.473，p < 0.001）、左心房面积（r = 0.458，p < 0.001）、左心房面积指数（r = 0.334且p = 0.007）和左心房容积指数（r = 0.304，p = 0.01）之间存在中度正相关。每年AF发作次数和BMI值影响IL-6血水平（分别为t = 3.46，p = 0.001和t = 2.17，p = 0.03）。
无论是否接受RAAS抑制剂治疗，AF患者均存在炎症，且炎症与AF持续时间延长、左心房直径和左心房容积相关。作用于心脏基质并减轻炎症过程的ACE抑制剂和ARB可能具有降低AF负荷的治疗保护作用。
