Preoperative Serum Receptor Activator of Nuclear Factor-κB Ligand/Osteoprotegerin Predict Stabilization of Spontaneously Restored Sinus Rhythm in Persistent Atrial Fibrillation Patients after Mitral Valve Surgery

Abstract

Objective: The osteoprotegerin (OPG)/receptor activator of nuclear factor-κB (RANK)/RANK ligand (RANKL) axis may play an important role in the stabilization of restored sinus rhythm (SR) after mitral valve (MV) surgery by stimulating atrial fibrillation (AF)-related atrial remodeling in AF patients. Herein, we investigated the association between preoperative serum soluble RANKL (sRANKL)/OPG and the stabilization of restored SR after MV surgery. Methods: Persistent AF patients who had spontaneously restored SR after MV replacement were enrolled (n = 203). Comparison was made between patients without AF recurrence (n = 71) and patients experiencing recurrence (n = 132). Results: Patients experiencing recurrence had higher serum levels of sRANKL, OPG and sRANKL/OPG ratio than patients without recurrence. Multivariate survival regression analysis showed that clinical factors such as duration of AF, left atrial diameter and left atrial thrombosis, as well as serum sRANKL level and the sRANKL/OPG ratio, were independent predictors of AF recurrence. Receiver operating characteristic curve analysis showed that the best diagnostic values of the serum sRANKL level and the sRANKL/OPG ratio for predicting recurrence were 3.44 pmol/l and 0.53, respectively. Conclusions: Patients who had a low preoperative serum sRANKL level and sRANKL/OPG ratio are likely to have a stable spontaneously restored SR postoperatively. Thus, we suggest that patients at high risk of early AF recurrence should be considered for concomitant surgical cardioversion during MV surgery.