Plasma transforming growth factor β1 as a biochemical marker to predict the persistence of atrial fibrillation after the surgical maze procedure

On, Young Keun; Jeon, Eun-Seok; Lee, Sang Yeub; Shin, Dae-Hee; Choi, Jin-Oh; Sung, Jidong; Kim, June Soo; Sung, Kiick; Park, PyoWon

doi:10.1016/j.jtcvs.2008.10.022

« Previous Next »The Journal of Thoracic and Cardiovascular Surgery
Volume 137, Issue 6 , Pages 1515-1520, June 2009

Plasma transforming growth factor β1 as a biochemical marker to predict the persistence of atrial fibrillation after the surgical maze procedure

Young Keun On, MD, PhD
- Division of Cardiology, Department of Medicine, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
Eun-Seok Jeon, MD, PhD
- Division of Cardiology, Department of Medicine, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Address for reprints: Eun-Seok Jeon, MD, PhD, Division of Cardiology, Department of Medicine, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Kangnam-gu, 135-710, Seoul, Korea.
Sang Yeub Lee, MD
- Division of Cardiology, Department of Medicine, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
Dae-Hee Shin, MD
- Division of Cardiology, Department of Medicine, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
Jin-Oh Choi, MD
- Division of Cardiology, Department of Medicine, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
Jidong Sung, MD, MPH
- Division of Cardiology, Department of Medicine, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
June Soo Kim, MD, PhD
- Division of Cardiology, Department of Medicine, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
Kiick Sung, MD
- Department of Thoracic and Cardiovascular Surgery, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
PyoWon Park, MD, PhD
- Department of Thoracic and Cardiovascular Surgery, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

Received 10 July 2008; received in revised form 17 September 2008; accepted 16 October 2008.

Objectives

The Cox maze procedure was developed as a surgical treatment for atrial fibrillation. However, atrial fibrillation recurs in some patients, and atrial remodeling in the form of fibrosis can lead to perpetuation of atrial fibrillation. To identify the predictor of the persistence of atrial fibrillation after the maze procedure using cryoablation, we evaluated the preoperative plasma transforming growth factor β1. We also examined the correlations between plasma transforming growth factor β1 levels and the degree of atrial fibrosis.

Methods

Preoperative plasma transforming growth factor β1 levels were measured in 86 consecutive patients (age, 54 ± 12 years) who underwent both the open heart operation for valvular heart disease and the surgical maze procedure with cryoablation for persistent atrial fibrillation. We measured the degree of fibrosis from the tissue of the left atrium.

Results

At 1 year's follow-up, 10 of 86 patients had persistent atrial fibrillation. Patients with persistent atrial fibrillation had higher preoperative plasma transforming growth factor β1 levels than the patients with sinus rhythm (0.44 ± 0.29 vs 0.32 ± 0.15 ng/mL, P = .03). Patients with persistent atrial fibrillation had higher mRNA expressions of collagen III and lower mRNA expressions of atrial natriuretic peptide than those with sinus rhythm, and the plasma transforming growth factor β1 levels correlated with the degree of fibrosis in the left atrium (r = 0.497, P = .022). Multiple logistic regression analysis revealed that plasma transforming growth factor β1 levels were independently associated with the postoperative persistence of atrial fibrillation at 1 year's follow-up.

Conclusions

Preoperative plasma transforming growth factor β1 levels could be used to predict the persistence of atrial fibrillation at 1 year's follow-up after the surgical maze procedure by using cryoablation. Preoperative plasma transforming growth factor β1 levels were correlated with the degree of fibrosis in the left atria of patients with mitral valvular heart disease.

Abbreviations and Acronyms: AF, atrial fibrillation, ANP, atrial natriuretic peptide, ECG, electrocardiogram, ELISA, enzyme-linked immunosorbent assay, MMP, matrix metalloproteinase, SR, sinus rhythm, TGF, transforming growth factor