First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland, 47 Ziołowa St., 40-635 Katowice, Poland.
Kardiol Pol. 2018;76(8):1232-1241. doi: 10.5603/KP.a2018.0108. Epub 2018 Jun 26.
Renalase is a catecholamine-metabolising enzyme, but its possible association with atrial fibrillation (AF) remains unknown.
We sought to evaluate plasma renalase concentration in patients with AF undergoing pulmonary vein isolation (PVI) with respect to AF clinical characteristics, left atrial (LA) remodelling, and PVI efficacy.
This case-control study included 69 patients (median age 58 years) with either paroxysmal (89%) or persistent (11%) AF, referred for PVI, and a control group consisting of 15 patients without AF, matched for age, sex, and comorbidi-ties. An evaluation of transthoracic echocardiography with LA speckle tracking and plasma renalase concentration using an enzyme-linked immunosorbent assay was performed. AF recurrence was defined as any AF episode on seven-day electro-cardiographic monitoring at six-month follow-up.
Renalase level was higher in the study group than in the control group (mean 27.99 vs. 21.48 μg/mL, p = 0.004), but it was lower in patients with persistent AF (19.05 vs. 28.77 μg/mL; p = 0.023) and among patients with AF episodes di-rectly preceding PVI (24.50 vs. 29.66 μg/mL; p = 0.04). Renalase concentration within the first quartile was associated with higher mean heart rate (70 vs. 61 bpm, p = 0.029), greater AF burden (36.9% vs. 9.3%, p = 0.027), greater LA diameter (41.1 vs. 37.9 mm, p = 0.011), and a trend towards less negative global LA strain (-9.4 vs. -13.5, p = 0.082). Logistic regres-sion revealed that global four-chamber LA strain was the only independent predictor of renalase variability (p = 0.0045). Renalase concentration did not predict AF recurrence at six-month follow-up (area under curve [AUC] = 0.614, p = 0.216).
Low renalase level may be associated with impaired rate control, higher AF burden, and advanced LA remodel-ling in AF patients undergoing PVI, but it does not predict sinus rhythm maintenance.
肾酶是一种儿茶酚胺代谢酶，但它与心房颤动（AF）的可能关联尚不清楚。
我们旨在评估接受肺静脉隔离（PVI）的 AF 患者的血浆肾酶浓度与 AF 临床特征、左心房（LA）重构和 PVI 效果的关系。
本病例对照研究纳入了 69 名（中位年龄 58 岁）阵发性（89%）或持续性（11%）AF 患者，他们因 PVI 而就诊，对照组由 15 名无 AF 的患者组成，年龄、性别和合并症相匹配。使用酶联免疫吸附试验（ELISA）进行经胸超声心动图检查和 LA 斑点追踪，并评估血浆肾酶浓度。AF 复发定义为在 6 个月随访时的 7 天心电图监测中出现任何 AF 发作。
研究组的肾酶水平高于对照组（平均 27.99 与 21.48 μg/mL，p = 0.004），但持续性 AF 患者的肾酶水平较低（19.05 与 28.77 μg/mL，p = 0.023），且在 PVI 前直接出现 AF 发作的患者中较低（24.50 与 29.66 μg/mL，p = 0.04）。第一个四分位数内的肾酶浓度与平均心率较高（70 与 61 bpm，p = 0.029）、AF 负荷较大（36.9%与 9.3%，p = 0.027）、LA 直径较大（41.1 与 37.9 mm，p = 0.011）和负性 LA 整体应变较小（-9.4 与-13.5，p = 0.082）相关。逻辑回归显示，LA 整体四腔应变是肾酶变异性的唯一独立预测因素（p = 0.0045）。肾酶浓度不能预测 6 个月时的 AF 复发（曲线下面积 [AUC] = 0.614，p = 0.216）。
低肾酶水平可能与接受 PVI 的 AF 患者的心率控制不佳、AF 负荷较高和 LA 重构进展有关，但它不能预测窦性节律的维持。
