Jiang ZhiZhi, Lin YaZhou, Ding Hang, Lian LiangHua, Chen JianQuan, Wu MeiQiong, Chen Xin, Zhang JianCheng
Shengli Clinical Medical College of Fujian Medical University, No. 134, East Street, Gulou District, Fuzhou, Fujian, 350000, China.
BMC Cardiovasc Disord. 2024 Dec 20;24(1):725. doi: 10.1186/s12872-024-04404-x.
Assessing whether serum Vascular Cell Adhesion Molecule 1(VCAM-1) concentration in the left atrial appendage(LAA) and the expression of VCAM-1 in LAA tissues are associated with the risk of atrial fibrillation-related stroke.
Blood samples were collected from atrial fibrillation(AF) patients scheduled for catheter ablation of AF, both from within the LAA and peripheral veins(PV). The serum concentration of VCAM-1 was quantitatively analyzed using ELISA. Additionally, LAA tissues were obtained from AF patients undergoing cardiac surgery, and immunohistochemical quantification was conducted to assess VCAM-1 expression in these tissues. Univariate analysis and multivariate logistic regression were performed to examine the association between VCAM-1 levels and the risk of atrial fibrillation-related stroke.
A total of 146 patients scheduled for AF ablation and 34 patients scheduled for cardiac surgery were enrolled in this study. Among these two groups, there were 67 cases (45.9%) and 13 cases (38.2%) of AF patients who experienced strokes, respectively. Serum analysis revealed that in the AF group with strokes, the LAA serum VCAM-1 concentration was higher compared to the AF group without strokes (631.64 ± 143.48 pg/ml vs. 336.71 ± 201.66 pg/ml, P < 0.001). Similarly, the PV serum VCAM-1 concentration was higher in the AF group with strokes compared to the group without strokes (591.65 ± 128.23 pg/ml vs. 257.71 ± 157.92 pg/ml, P < 0.001). Additionally, both the AF group with strokes and the group without strokes exhibited higher LAA serum VCAM-1 concentrations compared to PV serum concentrations (631.64 ± 143.48 pg/ml vs. 591.65 ± 128.23 pg/ml, P = 0.041) and (336.71 ± 201.66 pg/ml vs. 257.71 ± 157.92 pg/ml, P = 0.004).Regarding left atrial tissue analysis, the AF group with strokes had a higher average optical density value (AOD) of VCAM-1 compared to the group without strokes (1.257 ± 0.147 vs. 1.093 ± 0.161, P < 0.001), indicating a higher expression level of VCAM-1 in the LAA in the AF group with strokes. In univariate analysis, LAA serum VCAM-1 concentration (OR = 1.15, P < 0.001), PV VCAM-1 concentration (OR = 1.11, P < 0.001), and LAA VCAM-1 AOD value (OR = 3.04, P = 0.021) were all associated with the risk of atrial fibrillation-related stroke. In the multivariate logistic regression analysis, LAA serum VCAM-1 concentration (OR = 1.17, P = 0.002) and PV VCAM-1 concentration (OR = 1.30, P = 0.034) were predictive of atrial fibrillation-related stroke. Specifically, left atrial appendage serum VCAM-1 concentration greater than 387.93 pg/ml and peripheral vein VCAM-1 concentration greater than 344.04 pg/ml were predictive of atrial fibrillation-related strokes.
The risk of stroke in AF is associated with VCAM-1, and elevated serum VCAM-1 concentrations in AF patients who experience strokes may be attributed not only to systemic inflammatory responses but also to increased VCAM-1 expression in LAA tissues. Serum VCAM-1 concentrations in AF patients can serve as predictive factors for atrial fibrillation-related stroke, with LAA serum VCAM-1 concentrations exceeding 387.93 pg/ml and peripheral vein VCAM-1 concentrations exceeding 344.04 pg/ml being predictive of atrial fibrillation-related strokes.
评估左心耳（LAA）中血清血管细胞黏附分子1（VCAM-1）浓度及LAA组织中VCAM-1的表达与房颤相关性卒中风险是否相关。
从计划进行房颤导管消融的房颤患者的LAA内和外周静脉（PV）采集血样。采用酶联免疫吸附测定法（ELISA）定量分析血清VCAM-1浓度。此外，从接受心脏手术的房颤患者获取LAA组织，并进行免疫组织化学定量分析以评估这些组织中VCAM-1的表达。进行单因素分析和多因素逻辑回归分析以检验VCAM-1水平与房颤相关性卒中风险之间的关联。
本研究共纳入146例计划进行房颤消融的患者和34例计划进行心脏手术的患者。在这两组中，分别有67例（45.9%）和13例（38.2%）房颤患者发生卒中。血清分析显示，在发生卒中的房颤组中，LAA血清VCAM-1浓度高于未发生卒中的房颤组（631.64± 143.48 pg/ml对336.71± 201.66 pg/ml，P<0.001）。同样，发生卒中的房颤组的PV血清VCAM-1浓度高于未发生卒中的组（591.65± 128.23 pg/ml对257.71± 157.92 pg/ml，P<0.001）。此外，发生卒中的房颤组和未发生卒中的组的LAA血清VCAM-1浓度均高于PV血清浓度（631.64± 143.48 pg/ml对591.
