TY - JOUR
T1 - High recurrence of atrial fibrillation in patients with high tissue atrial natriuretic peptide and amyloid levels after concomitant maze and mitral valve surgery
AU - Park, Junbeom
AU - Lee, Seung Hyun
AU - Lee, Jihei Sara
AU - Park, Jae Hyung
AU - Joung, Boyoung
AU - Lee, Moon Hyoung
AU - Chang, Byung Chul
AU - Pak, Hui Nam
N1 - Funding Information:
This study was supported by a grant from the Korean Heart Rhythm Society ( KHRS2013-1 ) to Park J, from the Korea Health 21 R&D Project, Ministry of Health and Welfare ( A085136 ) to Pak HN, and the National Research Foundation of Korea (NRF) funded by the Ministry of Science, ICT & Future Planning (MSIP; 7-2013-0362 ) to Pak HN.
Publisher Copyright:
© 2016 Japanese College of Cardiology
PY - 2017/1/1
Y1 - 2017/1/1
N2 - Background Hemodynamic burden is thought to play a role in valvular atrial fibrillation (AF), but the detailed pathophysiology is unclear. We hypothesized that atrial natriuretic peptide (ANP) tissue levels and amyloid deposits in the left atrial appendage (LAA) were associated with the pre-operative hemodynamic status and post-operative rhythm outcome in patients undergoing a concomitant mitral valve and maze surgery. Methods We quantified the fibrosis, atrial amyloid deposits, ANP tissue levels, and multiple biomarker proteins (Western blot) in LAA tissues taken from 26 patients (53.8% male, 58.4 ± 9.7 years) who underwent concomitant maze and mitral valve surgery. The histologic and biochemical results were compared with the pre-operative pulmonary artery pressure (PAP) and post-operative rhythm outcome. Results The ANP tissue level was positively correlated with the atrial amyloid deposit areas (R = 0.880, p < 0.001), but not with the degree of fibrosis. The pre-operative systolic PAP negatively correlated with both the ANP tissue expression level (R = −0.467, p = 0.019) and atrial amyloid deposit area (R = −0.589, p = 0.008). The angiotensin II tissue expression level was significantly higher in tissues without ANP expression than in those with expression (p = 0.003). AF recurrence after the maze operation was significantly lower in patients without than in those with ANP expression (log rank p = 0.031, HR 3.779, 95% CI 1.163–12.277, p = 0.027). Conclusions A lower ANP atrial tissue expression and amyloid deposits were correlated with a high pre-operative hemodynamic loading, and those patients had a paradoxically lower AF recurrence after relief of the hemodynamic burden by concomitant maze and mitral valve surgery.
AB - Background Hemodynamic burden is thought to play a role in valvular atrial fibrillation (AF), but the detailed pathophysiology is unclear. We hypothesized that atrial natriuretic peptide (ANP) tissue levels and amyloid deposits in the left atrial appendage (LAA) were associated with the pre-operative hemodynamic status and post-operative rhythm outcome in patients undergoing a concomitant mitral valve and maze surgery. Methods We quantified the fibrosis, atrial amyloid deposits, ANP tissue levels, and multiple biomarker proteins (Western blot) in LAA tissues taken from 26 patients (53.8% male, 58.4 ± 9.7 years) who underwent concomitant maze and mitral valve surgery. The histologic and biochemical results were compared with the pre-operative pulmonary artery pressure (PAP) and post-operative rhythm outcome. Results The ANP tissue level was positively correlated with the atrial amyloid deposit areas (R = 0.880, p < 0.001), but not with the degree of fibrosis. The pre-operative systolic PAP negatively correlated with both the ANP tissue expression level (R = −0.467, p = 0.019) and atrial amyloid deposit area (R = −0.589, p = 0.008). The angiotensin II tissue expression level was significantly higher in tissues without ANP expression than in those with expression (p = 0.003). AF recurrence after the maze operation was significantly lower in patients without than in those with ANP expression (log rank p = 0.031, HR 3.779, 95% CI 1.163–12.277, p = 0.027). Conclusions A lower ANP atrial tissue expression and amyloid deposits were correlated with a high pre-operative hemodynamic loading, and those patients had a paradoxically lower AF recurrence after relief of the hemodynamic burden by concomitant maze and mitral valve surgery.
KW - Amyloid
KW - Atrial natriuretic peptide
KW - Maze surgery
KW - Valvular atrial fibrillation
UR - http://www.scopus.com/inward/record.url?scp=84994311228&partnerID=8YFLogxK
U2 - 10.1016/j.jjcc.2016.07.012
DO - 10.1016/j.jjcc.2016.07.012
M3 - Article
C2 - 27567174
AN - SCOPUS:84994311228
SN - 0914-5087
VL - 69
SP - 345
EP - 352
JO - Journal of Cardiology
JF - Journal of Cardiology
IS - 1
ER -