Seljeflot Ingebjorg, R Ulimoen Sara, Enger Steve, Bratseth Vibeke, Arnesen Harald, Tveit Arnljot
Center for Clinical Heart Research, Oslo University Hospital Ulleval, Norway; Department of Cardiology, Oslo University Hospital Ulleval, Norway; Faculty of Medicine, University of Oslo, Norway.
Medical Research Department, Department of Medicine, Vestre Viken Hospital Trust, Rud, Norway.
Cardiol Res. 2012 Jun;3(3):109-115. doi: 10.4021/cr175w. Epub 2012 May 20.
The importance of endothelial dysfunction in atrial fibrillation (AF) is not clarified. The aim of this study was to evaluate endothelial dysfunction assessed by selected inflammatory and haemostatic endothelial markers and nitric oxide (NO) associated variables as related to the presence of AF in an elderly population. NO is known to express anti-thrombotic as well as vasoactive properties.
This is a cross sectional study of 75-year old subjects with AF (n = 62) and control subjects in sinus rhythm (n = 124), matched for gender. Fasting blood samples were collected for analyses of asymmetric dimethylarginine (ADMA), an endogenous inhibitor of NO-synthase, L-arginine, E-selectin, vascular cell adhesion molecule-1 (VCAM-1) and von Willebrand factor (vWF).
Levels of vWF and ADMA were significantly higher in AF patients vs controls (P = 0.023 and P < 0.001, respectively) and the L-arginine/ADMA ratios were lower (P = 0.015), the latters still significant after adjustment for relevant covariates (P = 0.007 and P = 0.037, respectively). No significant differences in the levels of VCAM-1 and E-selectin were observed between the groups. When dividing the ADMA levels into quartiles there was a significant trend for having AF with increasing levels of ADMA (P < 0.001) with a cut-off at the 25th percentile (< 0.54 µmol/L), giving an adjusted OR for having AF of 12.46 (95% CI 3.11 - 49.86) (P < 0.001) with higher levels. A similar inverse trend was seen for the L-arginine/ADMA ratio.
Our population of 75-year-old AF patients had significantly impaired endothelial function assessed by increased levels of vWF, and more pronounced by high levels of ADMA. The results indicate AF in the elderly to be closely associated with the regulatory pathway of NO.
内皮功能障碍在心房颤动（AF）中的重要性尚未明确。本研究旨在评估通过选定的炎症和止血内皮标志物以及与一氧化氮（NO）相关的变量所评估的内皮功能障碍与老年人群中AF的存在之间的关系。已知NO具有抗血栓形成以及血管活性特性。
这是一项对75岁AF患者（n = 62）和窦性心律对照受试者（n = 124）进行的横断面研究，按性别匹配。采集空腹血样用于分析不对称二甲基精氨酸（ADMA），一种内源性一氧化氮合酶抑制剂，L-精氨酸，E-选择素，血管细胞粘附分子-1（VCAM-1）和血管性血友病因子（vWF）。
AF患者的vWF和ADMA水平显著高于对照组（分别为P = 0.023和P < 0.001），L-精氨酸/ADMA比值较低（P = 0.015），在调整相关协变量后后者仍具有显著性（分别为P = 0.007和P = 0.037）。两组之间VCAM-1和E-选择素水平未观察到显著差异。当将ADMA水平分为四分位数时，随着ADMA水平升高，患AF有显著趋势（P < 0.001），在第25百分位数（< 0.54 μmol/L）处有一个临界值，较高水平时患AF的校正比值比为12.46（95% CI 3.11 - 49.86）（P < 0.001）。L-精氨酸/ADMA比值也有类似的反向趋势。
我们的75岁AF患者群体通过vWF水平升高评估显示内皮功能显著受损，而高水平的ADMA使其更明显。结果表明老年人中的AF与NO调节途径密切相关。
