Sharma Gautam, Ghati Nirmal, Sharique Mohd, Sharma Shruti, Shetkar Sudhir, Karmakar Suman, Naik Nitish, Lakshmy Ramakrishnan, Thakur Bhaskar, Agarwal Aman, Saxena Anita
Department of Cardiology All India Institute of Medical Sciences New Delhi India.
Department of Pathology, National Institute of Pathology, Indian Council of Medical Research, Safdarjung Hospital campus New Delhi India.
J Arrhythm. 2020 Sep 4;36(6):1007-1015. doi: 10.1002/joa3.12428. eCollection 2020 Dec.
Inflammation has been implicated in the initiation and perpetuation of non-valvular atrial fibrillation (AF). However, there is a lack of similar data on AF in rheumatic heart disease (RHD). The objective of this study was to analyze the association of inflammation as measured by serum inflammatory biomarkers with AF in rheumatic mitral stenosis (Rh-MS).
A comparative cross-sectional analytical study was conducted on 181 Rh-MS patients in normal sinus rhythm (NSR; n = 69), subclinical transient AF (SCAF; detected by 24-hours Holter monitoring; n = 30) and chronic AF (n = 82). Serum hs-CRP, IL-6, and sCD-40L were assessed using ELISA immunoassay and compared in all groups of Rh-MS with or without AF.
We found significantly higher serum hs-CRP and sCD-40L levels in the overall AF (Chronic AF + SCAF) group (: 4.5 ± 3.4 vs 2.3 ± 2.9 mg/L, < .01; : 6.4 ± 4.8 vs 3.1 ± 3.4 ng/mL, < .01) and chronic AF subgroup (: 4.9 ± 3.4 vs 2.3 ± 2.9 mg/L, < .01; : 6.9 ± 5.1 vs 3.1 ± 3.4 ng/mL, < .01) compared to patients with sinus rhythm. There was a statistically significant graded increase of serum IL-6 level from the NSR to the SCAF (: 6.8 ± 3.9 vs 4.0 ± 2.2 pg/mL, = .03), and chronic AF subgroups (: 9.3 ± 6.5 vs 4.0 ± 2.2 pg/mL, < .01; vs : 9.3 ± 6.5 vs 6.8 ± 3.9, = .05) of atrial fibrillation.
Elevated levels of serum hs-CRP, IL-6, and sCD-40L were strongly associated with overall AF and also with SCAF and chronic AF in Rh-MS patients indicating a potential role of inflammation in the pathophysiology of rheumatic AF.
炎症与非瓣膜性心房颤动（AF）的发生和持续存在有关。然而，关于风湿性心脏病（RHD）患者发生AF的类似数据尚缺乏。本研究的目的是分析血清炎症生物标志物所测定的炎症与风湿性二尖瓣狭窄（Rh-MS）患者AF之间的关联。
对181例处于正常窦性心律（NSR；n = 69）、亚临床短暂性AF（SCAF；通过24小时动态心电图监测检测到；n = 30）和慢性AF（n = 82）的Rh-MS患者进行了一项比较性横断面分析研究。使用酶联免疫吸附测定法评估血清高敏C反应蛋白（hs-CRP）、白细胞介素-6（IL-6）和可溶性细胞间黏附分子-40配体（sCD-40L），并在所有有或无AF的Rh-MS组中进行比较。
我们发现，总体AF（慢性AF + SCAF）组的血清hs-CRP和sCD-40L水平显著更高（分别为：4.5±3.4 vs 2.3±2.9mg/L，P <.01；分别为：6.4±4.8 vs 3.1±3.4ng/mL，P <.01），慢性AF亚组也是如此（分别为：4.9±3.4 vs 2.3±2.9mg/L，P <.01；分别为：6.9±5.1 vs 3.1±3.4ng/mL，P <.01），与窦性心律患者相比。从NSR组到SCAF组，血清IL-6水平有统计学意义的分级升高（分别为：6.8±3.9 vs 4.0±2.2pg/mL，P = 0.03），房颤的慢性AF亚组也是如此（分别为：9.3±6.5 vs 4.0±2.2pg/mL，P <.01；与SCAF组相比：9.3±6.5 vs 6.8±3.9，P = 0.05）。
血清hs-CRP、IL-6和sCD-40L水平升高与Rh-MS患者的总体AF以及SCAF和慢性AF密切相关，表明炎症在风湿性AF的病理生理学中具有潜在作用。
