Department of Cardiology, The Royal Melbourne Hospital, Melbourne, VIC, Australia.
Department of Medicine, The University of Melbourne, Royal Melbourne Hospital, Parkville, VIC, Australia.
Europace. 2017 Aug 1;19(8):1280-1287. doi: 10.1093/europace/euw246.
Angiotensin converting enzyme 2 (ACE2) is an integral membrane protein whose main action is to degrade angiotensin II. Plasma ACE2 activity is increased in various cardiovascular diseases. We aimed to determine the relationship between plasma ACE2 activity and human atrial fibrillation (AF), and in particular its relationship to left atrial (LA) structural remodelling.
One hundred and three participants from a tertiary arrhythmia centre, including 58 with paroxysmal AF (PAF), 20 with persistent AF (PersAF), and 25 controls, underwent clinical evaluation, echocardiographic analysis, and measurement of plasma ACE2 activity. A subgroup of 20 participants underwent invasive LA electroanatomic mapping. Plasma ACE2 activity levels were increased in AF [control 13.3 (9.5-22.3) pmol/min/mL; PAF 16.9 (9.7-27.3) pmol/min/mL; PersAF 22.8 (13.7-33.4) pmol/min/mL, P = 0.006]. Elevated plasma ACE2 was associated with older age, male gender, hypertension and vascular disease, elevated left ventricular (LV) mass, impaired LV diastolic function and advanced atrial disease (P < 0.05 for all). Independent predictors of elevated plasma ACE2 activity were AF (P = 0.04) and vascular disease (P < 0.01). There was a significant relationship between elevated ACE2 activity and low mean LA bipolar voltage (adjusted R2 = 0.22, P = 0.03), a high proportion of complex fractionated electrograms (R2 = 0.32, P = 0.009) and a long LA activation time (R2 = 0.20, P = 0.04).
Plasma ACE2 activity is elevated in human AF. Both AF and vascular disease predict elevated plasma ACE2 activity, and elevated plasma ACE2 is significantly associated with more advanced LA structural remodelling.
血管紧张素转换酶 2（ACE2）是一种整合膜蛋白，其主要作用是降解血管紧张素 II。在各种心血管疾病中，血浆 ACE2 活性增加。我们旨在确定血浆 ACE2 活性与人类心房颤动（AF）之间的关系，特别是与左心房（LA）结构重塑的关系。
我们从一个三级心律失常中心招募了 103 名参与者，包括 58 名阵发性 AF（PAF）患者、20 名持续性 AF（PersAF）患者和 25 名对照者，进行了临床评估、超声心动图分析和血浆 ACE2 活性测量。一个亚组的 20 名参与者接受了经皮 LA 电解剖映射。AF 患者的血浆 ACE2 活性水平升高[对照组 13.3（9.5-22.3）pmol/min/mL；PAF 组 16.9（9.7-27.3）pmol/min/mL；PersAF 组 22.8（13.7-33.4）pmol/min/mL，P=0.006]。升高的血浆 ACE2 与年龄较大、男性、高血压和血管疾病、左心室（LV）质量增加、LV 舒张功能受损和晚期心房疾病相关（所有 P<0.05）。升高的血浆 ACE2 活性的独立预测因素是 AF（P=0.04）和血管疾病（P<0.01）。升高的 ACE2 活性与低平均 LA 双极电压（调整后的 R2=0.22，P=0.03）、复杂碎裂电图的高比例（R2=0.32，P=0.009）和 LA 激活时间延长（R2=0.20，P=0.04）之间存在显著关系。
在人类 AF 中，血浆 ACE2 活性升高。AF 和血管疾病均预测血浆 ACE2 活性升高，升高的血浆 ACE2 与更晚期的 LA 结构重塑显著相关。
