Abstract
Introduction: Atrial fibrosis plays an important role in atrial remodeling and the development of atrial fibrillation (AF). Transforming growth factor β1 (TGFβ1) is one of the major factors that accelerate atrial fibrosis. Left atrium global peak longitudinal strain (GPLS) measured by two-dimensional speckle tracking (2DS) method has been reported to be a useful method to predict the degree of atrial fibrosis. Hypothesis: To investigate the association between GPLS, Af and atrial fibrotic remodeling by analyzing fibrosis-relating gene expression including collagen type 1 (COL1A1), and TGFβ1 in cardiovascular surgery patients. Methods: Conventional echocardiography and 2DS method were performed in 117 patients (36 atrial fibrillation (Af) patients, 81 patients with sinus rhythm (SR), average age 69.7 years, 69 males) before cardiovascular surgery including cardiac valve replacement, and CABG. The fibrosis-relating gene expression such as collagen type 1 (COL1A1), COL4A1, TGFβ1, and connective tissue growth factor (CTGF) mRNA were analyzed by real-time reverse transcription polymerase chain reaction (RT-PCR) in 39 cases in which LA tissues were removed from the appendage during surgery. Results: GPLS was significantly negatively correlated with left atrial diameter (LAD), E/e‘, and left atrial volume index (LAVI). Expression of TGFβ1 in the atrium was positively correlated with expression level of Col1A1, Col4A1, and CTGF mRNA. GPLS was significantly negatively correlated with the expression of Col1A1 (r = -0.418, p = 0.015), TGFβ1 (r = -0.557, p = 0.000), and Col4A1 (r = -0.411, p = 0.013). However, no clear correlation was observed with LAD and LAVI. In multivariate analysis, unlike LAD and LAVI, GSLS was a clear predictor of Col1A1 expression, even when corrected with gender, age, brain natriuretic peptide (BNP), and type of heart rhythm (Af, sinus rhythm). On the other hand, TGFβ1 concentration in blood did not correlate with TGFβ1, Col1A1 and Col41A mRNA expression level in the atrium. Conclusions: Low LA GPLS exhibits increased atrial fibrosis reflected by collagen and TGFβ1 expression , irrespectively of heart rhythm (Af or sinus rhythm), and becomes an extremely useful marker for predicting LA fibrosis in cardiovascular surgery patients.
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