Department of Cardiology, Shanghai East Hospital, Shanghai, Tongji University School of Medicine, No. 150 Ji Mo Rd, Shanghai, 200120, People's Republic of China.
Department of Heart Failure, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China.
BMC Cardiovasc Disord. 2021 May 16;21(1):242. doi: 10.1186/s12872-021-02059-6.
To investigate whether inflammatory and growth factors (IGFs) were associated with incomplete device endothelialization (IDE) at 6 months after successful left atrial appendage closure (LAAC).
IDE after LAAC is correlated with device-related thrombus (DRT) formation and subsequent thromboembolic events. However, biomarkers for early detection of IDE remain lacking.
Plasma levels of IGFs including basic fibroblast growth factor (bFGF), platelet derived growth factor (PDGF), stromal cell derived factor (SDF)-1a, transforming growth factor (TGF)-β, vascular growth factor receptor-1 (VEGF-R) and von Willebrand factor (vWF) were determined using ELISA kits in 55 consecutive patients with atrial fibrillation (AF) at 6 months after LAAC with Watchman devices. The status of device endothelialization was assessed by transesophageal echocardiography and cardiac CT.
IDE and complete device endothelialization(CDE)were detected in 38 and 17 patients, respectively. Among the six IGFs, only plasma level of bFGF was significantly lower in patients with IDE compared to those with CDE (303.49 ± 246.84 vs. 556.31 ± 197.84 pg/ml, p < 0.001). C-statistics of plasma bFGF for discriminating patients with IDE from those with CDE was 0.785 (95 % CI: 0.663-0.907, p < 0.001), with a cut-off value of 440.52pg/ml (sensitivity 0.765; specificity 0.789). Multivariate logistic regression model showed that lower bFGF was an independent factor for IDE (OR: 11.752, 95 % CI: 2.869-48.144, P = 0.001). bFGF improved the classification of patients (NRI: 0.677,95 % CI: 0.320-1.033, p = 0.004).
Reduced plasma bFGF level confers an increased risk for IDE after LAAC. Further prospective studies are warranted to examine if bFGF could serve as a biomarker for IDE post LAAC.
研究左心耳封堵（LAAC）成功后 6 个月时，炎症和生长因子（IGFs）是否与不完全设备内皮化（IDE）相关。
LAAC 后 IDE 与器械相关血栓（DRT）形成及随后的血栓栓塞事件相关。然而，早期检测 IDE 的生物标志物仍缺乏。
使用 ELISA 试剂盒检测 55 例房颤（AF）患者 LAAC 后 6 个月时的 IGFs，包括碱性成纤维细胞生长因子（bFGF）、血小板衍生生长因子（PDGF）、基质细胞衍生因子（SDF）-1a、转化生长因子（TGF）-β、血管生成因子受体-1（VEGF-R）和血管性血友病因子（vWF）。通过经食管超声心动图和心脏 CT 评估设备内皮化的状态。
IDE 和完全设备内皮化（CDE）分别在 38 例和 17 例患者中检测到。在这 6 种 IGFs 中，只有 IDE 患者的血浆 bFGF 水平明显低于 CDE 患者（303.49±246.84pg/ml 比 556.31±197.84pg/ml，p<0.001）。bFGF 区分 IDE 患者和 CDE 患者的 C 统计量为 0.785（95%CI：0.663-0.907，p<0.001），截断值为 440.52pg/ml（灵敏度 0.765；特异性 0.789）。多变量逻辑回归模型显示，较低的 bFGF 是 IDE 的独立因素（OR：11.752，95%CI：2.869-48.144，P=0.001）。bFGF 改善了患者的分类（NRI：0.677，95%CI：0.320-1.033，p=0.004）。
LAAC 后血浆 bFGF 水平降低与 IDE 风险增加相关。需要进一步的前瞻性研究来检验 bFGF 是否可以作为 LAAC 后 IDE 的生物标志物。
