Mlodawska Elzbieta, Tomaszuk-Kazberuk Anna, Lopatowska Paulina, Waszkiewicz Ewa, Bachorzewska-Gajewska Hanna, Malyszko Jolanta, Michniewicz Ewelina, Dobrzycki Slawomir, Musial Wlodzimierz Jerzy
Department of Cardiology, Medical University of Bialystok, Bialystok, Poland.
Department of Invasive Cardiology, Medical University of Bialystok, Bialystok, Poland; Department of Clinical Medicine, Medical University of Bialystok, Bialystok, Poland.
Cardiorenal Med. 2016 Nov;7(1):11-20. doi: 10.1159/000448225. Epub 2016 Aug 12.
There is not much data on matrix metalloproteinase neutrophil gelatinase-associated lipocalin (MMP-NGAL) complex in patients with atrial fibrillation (AF).
The aim of the study was to assess the value of MMP-NGAL complex in predicting AF recurrence after electrical cardioversion.
The serum levels of NGAL, cystatin C, interleukin-6, high-sensitivity C-reactive protein, copeptin, MMP-NGAL complex, matrix metalloproteinase 2, tissue inhibitor of metalloproteinase 1, Von Willebrand factor, B-type natriuretic peptide and the urinary level of NGAL were evaluated before cardioversion.
A total of 83 patients with persistent AF were enrolled in the study. Left atrial diameter (LA) ≥4.5 cm was significantly associated with AF recurrence at follow-up (p = 0.009). In selected 39 obese patients, MMP-NGAL complex was associated with AF recurrence (p = 0.03). If the concentration of MMP-NGAL complex increased by 1 ng/ml, the odds of AF recurrence increased by 4% (OR 1.04; CI: 1.00-1.08; p = 0.03). MMP-NGAL complex did not correlate with AF recurrence in patients with a first episode of AF, in patients ≥65 years of age and in patients with a LA ≥4.5 cm or with chronic kidney disease.
It is known that the greater the BMI at baseline, the higher the likelihood of progression from paroxysmal to permanent AF. However, European Society of Cardiology (ESC) guidelines do not consider obese patients a population with a low likelihood of success of cardioversion. That is why we need a sensitive marker to predict sinus rhythm maintenance in such a population. We found that MMP-NGAL complex may predict AF recurrence after successful cardioversion in obese patients.
关于心房颤动（AF）患者中基质金属蛋白酶中性粒细胞明胶酶相关脂质运载蛋白（MMP-NGAL）复合物的数据不多。
本研究旨在评估MMP-NGAL复合物在预测电复律后房颤复发中的价值。
在电复律前评估血清中NGAL、胱抑素C、白细胞介素-6、高敏C反应蛋白、 copeptin、MMP-NGAL复合物、基质金属蛋白酶2、金属蛋白酶组织抑制剂1、血管性血友病因子、B型利钠肽水平以及尿中NGAL水平。
本研究共纳入83例持续性房颤患者。随访时左心房直径（LA）≥4.5 cm与房颤复发显著相关（p = 0.009）。在选定的39例肥胖患者中，MMP-NGAL复合物与房颤复发相关（p = 0.03）。MMP-NGAL复合物浓度每增加1 ng/ml，房颤复发几率增加4%（OR 1.04；CI：1.00 - 1.08；p = 0.03）。MMP-NGAL复合物在首次发作房颤的患者、≥65岁的患者以及LA≥4.5 cm或患有慢性肾脏病的患者中与房颤复发无关。
已知基线时体重指数越高，从阵发性房颤进展为永久性房颤的可能性越大。然而，欧洲心脏病学会（ESC）指南并未将肥胖患者视为电复律成功率低的人群。这就是为什么我们需要一个敏感的标志物来预测这类人群的窦性心律维持情况。我们发现MMP-NGAL复合物可能预测肥胖患者成功电复律后房颤的复发。
