Department of Cardiology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
Department of Cardiology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
Heart Lung Circ. 2019 Jun;28(6):923-931. doi: 10.1016/j.hlc.2018.05.094. Epub 2018 May 14.
Left atrial appendage (LAA) is gaining increasing attention in patients with atrial fibrillation (AF) in the context of cardioembolic stroke. Galectin-3 (Gal-3) is a mediator of profibrotic pathways and is associated with an increased incidence of heart failure. However, the role of Gal-3 in LAA remodelling and thrombus formation in AF has not been evaluated.
This prospective study included 153 consecutive patients with paroxysmal (n=58), persistent (n=55) or permanent (n=40) nonvalvular AF. The serum level of Gal-3 was measured by enzyme-linked immunosorbent assay. The morphology and function of LAA were determined by transoesophageal echocardiography.
Left atrial appendage thrombus was observed in 22 patients (2 in paroxysmal AF, 11 in persistent AF and 9 in permanent AF). Significant differences among patients with different types of AF were found in terms of LAA morphology (orifice diameter and depth) and function (flow velocity and tissue Doppler contracting velocity) as well as serum levels of Gal-3. Furthermore, patients with persistent or permanent AF had higher levels of Gal-3. High Gal-3 level was closely related to LAA flow velocity and occurrence of LAA thrombus. Multivariate logistic regression analysis revealed that Gal-3 was an independent determinant of LAA thrombus in patients with AF. Receiver operating characteristic (ROC) curves related to LAA thrombus formation established a cut-off point for Gal-3 >18.95ng/ml.
Cardiac rhythm disturbances caused by AF may lead to morphologic and functional remodelling of LAA. The serum level of Gal-3 was significantly correlated with LAA remodelling in patients with AF. High levels of Gal-3 were also a predicator for LAA thrombus formation.
左心耳（LAA）在心房颤动（AF）患者中的心源性栓塞性中风中越来越受到关注。半乳糖凝集素-3（Gal-3）是促纤维化途径的介质，与心力衰竭的发生率增加有关。然而，Gal-3 在 AF 中 LAA 重塑和血栓形成中的作用尚未得到评估。
这项前瞻性研究纳入了 153 例阵发性（n=58）、持续性（n=55）或永久性（n=40）非瓣膜性 AF 患者。通过酶联免疫吸附试验测量 Gal-3 的血清水平。通过经食管超声心动图确定 LAA 的形态和功能。
22 例患者（阵发性 AF 2 例，持续性 AF 11 例，永久性 AF 9 例）观察到 LAA 血栓。不同类型 AF 患者的 LAA 形态（口部直径和深度）和功能（流速和组织多普勒收缩速度）以及 Gal-3 血清水平存在显著差异。此外，持续性或永久性 AF 患者的 Gal-3 水平较高。高 Gal-3 水平与 LAA 流速和 LAA 血栓形成密切相关。多变量逻辑回归分析显示，Gal-3 是 AF 患者 LAA 血栓形成的独立决定因素。与 LAA 血栓形成相关的受试者工作特征（ROC）曲线确定了 Gal-3 >18.95ng/ml 的切点。
AF 引起的心律紊乱可能导致 LAA 的形态和功能重塑。AF 患者的 Gal-3 血清水平与 LAA 重塑显著相关。高水平的 Gal-3 也是 LAA 血栓形成的预测因子。
