Center for Comprehensive Treatment of Atrial Fibrillation, Department of Cardiothoracic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, 200433, China.
Department of Ultrasound, Changzheng Hospital, Second Military Medical University, Shanghai, 200433, China.
Heart Lung Circ. 2019 Nov;28(11):1697-1705. doi: 10.1016/j.hlc.2018.08.010. Epub 2018 Sep 7.
Activin A secreted by epicardial adipose tissue (EAT) plays a major role in the progress of atrial fibrosis. However, the potential of Activin A in predicting the occurrence of postoperative atrial fibrillation (POAF) has yet to be elucidated. We aimed to investigate the predicable value of Activin A expression in EAT on POAF.
A total of 89 patients receiving cardiac surgery without atrial fibrillation (AF) history were enrolled in this study, including 49 patients with valvular heart disease (VHD) and 40 patients with non-valvular heart disease (NVHD). Activin A expression in EAT was determined by quantitative polymerase chain reaction (qPCR), while the thickness of EAT (EATT) was estimated by echocardiography. New onset POAF before discharge was documented.
Eventually 32 patients (36.0%) developed POAF, including 20 patients with VHD (40.8%) and 12 patients with NVHD (30.0%). Activin A expression was higher in POAF than sinus rhythm (SR) patients, whether for VHD or NVHD group (All p<0.001). In general, Activin A expression predicted the occurrence of POAF with a sensitivity of 65.6% and specificity of 91.2% (AUC: 0.795; 95%CI: 0.693-0.897, p<0.001). Subgroup analysis showed that EATT was not significant for the VHD group in predicting POAF (p=0.07), while Activin A expression demonstrated a sensitivity of 60.0% and specificity of 89.7% (AUC: 0.745; 95%CI: 0.601-0.889, p<0.001). Multivariate regression analysis showed that Activin A expression in EAT was an independent risk factor for POAF (OR: OR=1.067, 95%CI:1.002-1.136, p=0.042).
Activin A expression in EAT is an independent risk factor for POAF, which can be used for prediction of POAF, especially for patients with VHD.
心外膜脂肪组织（EAT）分泌的激活素 A 在心房纤维化的进展中起着重要作用。然而，激活素 A 在预测术后心房颤动（POAF）发生中的潜力尚未阐明。我们旨在研究 EAT 中激活素 A 表达对 POAF 的预测价值。
本研究共纳入 89 例无心房颤动（AF）病史的心脏手术患者，其中瓣膜性心脏病（VHD）患者 49 例，非瓣膜性心脏病（NVHD）患者 40 例。通过定量聚合酶链反应（qPCR）测定 EAT 中激活素 A 的表达，通过超声心动图估计 EAT 厚度（EATT）。记录出院前新发 POAF 的发生情况。
最终 32 例（36.0%）患者发生 POAF，其中 VHD 患者 20 例（40.8%），NVHD 患者 12 例（30.0%）。POAF 患者的激活素 A 表达高于窦性节律（SR）患者，无论 VHD 组还是 NVHD 组（均 p<0.001）。总的来说，激活素 A 表达对 POAF 的发生具有 65.6%的敏感性和 91.2%的特异性（AUC：0.795；95%CI：0.693-0.897，p<0.001）。亚组分析显示，EATT 对 VHD 组预测 POAF 无显著意义（p=0.07），而激活素 A 表达的敏感性为 60.0%，特异性为 89.7%（AUC：0.745；95%CI：0.601-0.889，p<0.001）。多变量回归分析显示，EAT 中激活素 A 的表达是 POAF 的独立危险因素（OR：1.067，95%CI：1.002-1.136，p=0.042）。
EAT 中激活素 A 的表达是 POAF 的独立危险因素，可用于预测 POAF，尤其是 VHD 患者。
