López-Gálvez Raquel, Rivera-Caravaca José Miguel, Mandaglio-Collados Darío, Ruiz-Alcaraz Antonio J, Lahoz-Tornos Álvaro, Hernández-Romero Diana, Orenes-Piñero Esteban, Ramos-Bratos María Pilar, Martínez Carlos M, Carpes Marina, Arribas-Leal José María, Cánovas Sergio, Lip Gregory Y H, Marín Francisco
Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, University of Murcia, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), CIBERCV, Murcia, Spain.
Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, University of Murcia, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), CIBERCV, Murcia, Spain; Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John and Moores University, and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom; Faculty of Nursing, University of Murcia, Murcia, Spain.
Biomed J. 2025 Aug;48(4):100821. doi: 10.1016/j.bj.2024.100821. Epub 2024 Nov 26.
Postoperative atrial fibrillation (POAF) is common after cardiac surgery and related to endothelial activation and systemic inflammation. Herein, we investigate the pathophysiological mechanisms of AF through endothelial activation and cell-cell interactions related to the development of POAF.
Patients without previous AF undergoing cardiac surgery were studied. Permanent AF patients were included as positive controls. Interleukin (IL)-6, Von Willebrand factor (vWF), N-terminal pro-brain natriuretic peptide (NT-proBNP), and high sensitivity troponin T (hsTnT) were evaluated by electrochemiluminescence. Vascular cell adhesion molecule-1 (VCAM-1) and human Growth Differentiation Factor 15 (GDF-15) were assessed by ELISA. Connexins (Cxs) 40 and 43 were measured by tissue immunolabelling, and apoptosis by TUNEL assay.
We included 117 patients (median age 67: 27.8% female): 17 with permanent AF; 27 with POAF, and 73 with non-AF. Patients with permanent AF and POAF had higher levels of NT-proBNP, hs-TnT, apoptotic nuclei, and decreased Cx43 expression, compared to non-AF patients (all p-value <0.05). VCAM-1 and GDF-15 were significantly higher in permanent AF vs. non-AF (p = 0.013 and p = 0.035).
Greater endothelial activation and inflammation in AF patients compared to those without AF were found. The proinflammatory state in AF patients, in addition to the lower expression of Cx43, seems to be associated with atrial remodeling processes occurring in AF.
心脏手术后术后房颤（POAF）很常见，且与内皮激活和全身炎症反应有关。在此，我们通过与POAF发生相关的内皮激活和细胞间相互作用来研究房颤的病理生理机制。
对既往无房颤的心脏手术患者进行研究。纳入永久性房颤患者作为阳性对照。采用电化学发光法评估白细胞介素（IL）-6、血管性血友病因子（vWF）、N末端脑钠肽前体（NT-proBNP）和高敏肌钙蛋白T（hsTnT）。通过酶联免疫吸附测定法评估血管细胞黏附分子-1（VCAM-1）和人生长分化因子15（GDF-15）。通过组织免疫标记测定连接蛋白（Cxs）40和43，并通过TUNEL法检测细胞凋亡。
我们纳入了117例患者（中位年龄67岁：27.8%为女性）：17例永久性房颤患者；27例POAF患者和73例无房颤患者。与无房颤患者相比，永久性房颤和POAF患者的NT-proBNP、hs-TnT水平更高，凋亡核更多，Cx43表达降低（所有p值<0.05）。永久性房颤患者的VCAM-1和GDF-15显著高于无房颤患者（p = 0.013和p = 0.035）。
与无房颤患者相比，房颤患者的内皮激活和炎症反应更强烈。房颤患者的促炎状态，除了Cx43表达较低外，似乎与房颤时发生的心房重构过程有关。
