Institute of Cardiovascular Diseases, The First Affiliated Hospital of Dalian Medical University, Dalian, China
Institute of Cardiovascular Diseases, The First Affiliated Hospital of Dalian Medical University, Dalian, China.
J Am Heart Assoc. 2018 Mar 13;7(6):e008083. doi: 10.1161/JAHA.117.008083.
In atrial fibrillation (AF), a more extensively fibrotic left atrium (LA) provides a substrate for arrhythmias and increases risk of relapse following ablation. Fibrocytes are bone marrow-derived circulating mesenchymal progenitors that have been identified in the atrium of patients with AF who have valvular diseases. The present study investigates the associations between circulating fibrocytes and LA fibrosis or the prevalence of recurrence after ablation in patients with persistent AF.
We measured the proportion, differentiation, and migration of circulating fibrocytes from patients with persistent AF (n=40), those with paroxysmal AF (n=30), and sinus rhythm controls (n=30). LA low-voltage (fibrosis) area was identified by an electroanatomic mapping system, and patients were followed up for 1 year after ablation. The relationship between circulating fibrocyte percentage and LA low-voltage area or recurrence was assessed by multivariate regression analysis. Circulating fibrocyte percentage positively associated with LA low-voltage area in the persistent AF group, and circulating fibrocyte (≥4.05%) was a significant predictor of 1-year recurrence after ablation. Cultured fibrocytes exhibited enhanced potential of differentiation in the persistent AF group (67.58±1.54%) versus the paroxysmal AF group (56.67±1.52%) and sinus rhythm controls (48.43±1.79%). Furthermore, expression of fibroblast activation markers and cell migratory ability were also elevated in differentiated fibrocytes from patients with persistent AF. Transforming growth factor β1 and stromal cell-derived factor 1 were elevated in the plasma of patients with persistent AF and were shown to promote fibrocyte differentiation and migration, respectively.
In patients with persistent AF, increased circulating fibrocytes served as a marker of LA fibrosis and recurrence.
在心房颤动（AF）中，左心房（LA）纤维化程度更高，为心律失常提供了基质，并增加了消融后复发的风险。纤维细胞是骨髓来源的循环间充质祖细胞，已在患有瓣膜病的 AF 患者的心房中被识别。本研究调查了持续性 AF 患者循环纤维细胞与 LA 纤维化或消融后复发的相关性。
我们测量了 40 例持续性 AF 患者、30 例阵发性 AF 患者和 30 例窦性节律对照者循环纤维细胞的比例、分化和迁移。通过电解剖图系统识别 LA 低电压（纤维化）区域，并在消融后对患者进行 1 年随访。通过多元回归分析评估循环纤维细胞百分比与 LA 低电压区域或复发之间的关系。循环纤维细胞百分比与持续性 AF 组的 LA 低电压区域呈正相关，循环纤维细胞（≥4.05%）是消融后 1 年复发的显著预测因子。培养的纤维细胞在持续性 AF 组（67.58±1.54%）中表现出比阵发性 AF 组（56.67±1.52%）和窦性节律对照组（48.43±1.79%）更高的分化潜能。此外，来自持续性 AF 患者的分化纤维细胞中，成纤维细胞激活标志物的表达和细胞迁移能力也升高。持续性 AF 患者的血浆中 TGF-β1 和 SDF-1 升高，分别显示可促进纤维细胞分化和迁移。
在持续性 AF 患者中，循环纤维细胞的增加可作为 LA 纤维化和复发的标志物。
