[Serum levels of endothelin-1 and connective tissue growth factor are elevated in patients with atrial fibrillation and correlated with relapse following radiofrequency ablation]

Abstract

Objective: To investigate the changes in serum levels of endothelin-1 (ET-1) and connective tissue growth factor (CTGF) in patients with atrial fibrillation (AF) and their value for predicting recurrence of AF after radiofrequency ablation (RFCA).

Methods: Sixty-six patients with paroxysmal AF (PaAF) and 72 with persistent AF (PaAF) admitted in our hospital were recruited as AF group and 80 patients with sinus rhythm as the control group, and in all the participants, serum levels of ET-1 and CTGF were measured using ELISA and Western blotting. From 6 patients with AF and 6 with sinus rhythm undergoing cardiac surgery in our hospital, tissue samples of the right atrial appendage were taken intraoperatively for observation of structural changes of the cardiomyocytes, myocardial fibrosis and expression of ET-1 and CTGF protein. In AF group, the patients receiving RFCA were followed up for 6 months following the procedure for assessment of the outcomes.

Results: Compared with the control patients, the patients with AF showed obvious damages of the cardiomyocyte structure and myocardial fibrosis. Serum levels of ET-1 and CTGF levels were significantly higher in PaAF and PeAF groups than in the control group, and were higher in PeAF group than in PaAF group. In the patients with AF, serum ET-1 and CTGF levels were positively correlated with left atrial diameter (LAD) (P < 0.05), and ET-1 was positively correlated with CTGF levels (P < 0.05). In patients with postoperative AF recurrence, the serum levels of ET-1 and CTGF were significantly higher than those in patients without recurrence; serum ET-1 and CTGF levels before and after the operation were positively correlated with the recurrence of PeAF, and elevated serum levels of ET- 1 and CTGF were identified by logistic regression analysis as independent risk factors for postoperative recurrence of PeAF.

Conclusion: Serum levels of ET-1 and CTGF are significantly elevated in AF patients in positive correlation with AF duration. ET-1 and CTGF levels are higher in AF patients with postoperative recurrence, and they both have predictive value for recurrence of PeAF following RFCA.

Keywords: atrial fibrillation; clinical prognosis; connective tissue growth factor; endothelin-1; radiofrequency ablation.

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各组心肌细胞HE染色、Masson染色和免疫组织化学染色的结果 Results of HE staining, Masson staining and immunohistochemical staining of myocardial tissues in each group. A: HE staining and Masson staining of the myocardial tissues in control and AF groups. B: Collagen volume fraction in the control and AF groups. C: Expression of ET-1 and CTGF in the control and AF groups detected by immunohistochemistry. D: Quantitative analysis of ET-1 and CTGF expression. *P < 0.05 vs control group.

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ET-1和CTGF在各组血清单个核细胞中的蛋白含量分析 Western blotting of ET-1 and CTGF expressions in serum mononuclear cells (A) and quantitative analysis of their expression levels (B, C).*P < 0.05 vs CON, ***P < 0.001 vs CON, ^#P < 0.05 vs PaAF.

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ET-1和CTGF在各组右心耳中的蛋白含量分析 Western blotting of ET-1 and CTGF expressions in the right auricle (A) and quantitative analysis of the results (B, C).**P < 0.01 vs CON.

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AF患者血清ET-1、CTGF及LAD的相关性 Correlation of ET-1, CTGF and LAD in patients with AF. A: Correlation analysis of ET-1 and CTGF expressions with LAD. B: Correlation analysis between ET-1 and CTGF expressions.

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PeAF患者术前、术后ET-1和CTGF的相关性 Correlation between ET-1 and CTGF before and after operation in patients with PeAF.