| Background and objectivesAtrial fibrillation(AF)is one of the most common tachyarrhychiatric disorders in clinical.It can cause various complications such as heart failure,stroke and arterial embolism which is multiple,high disability and mortality.The incidence rate increases with age,which seriously affects the patient’s physical health and quality of life.Atrial fibrillation has become one of the key concerns in the cardiovascular field worldwide.At present,due to the poor therapeutic effect of atrial fibrillation,radiofrequency ablation(RPCA),which can cure atrial fibrillation in recent years has become an important means of treatment of atrial fibrillation.However,the high recurrence rate after AFCA is still an important factor plaguing doctors and patients,reducing the long-term efficacy of RFCA and increasing the pain and financial burden of patients receiving RFCA again.How to analyze the preoperative data of patients to predict whether recurrence after RFCA is of great significance for accurately screening patients with ablation,improving the efficiency of RFCA treatment,and reducing the recurrence rate.At present,some studies have found that some preoperative baseline characteristics and plasma biochemical markers in patients with atrial fibrillation can be used as predictors of AF recurrence after RFCA,but the correlation between specific genetic markers microRNA(miRNA)and the risk of postoperative AF recurrence after RFCA has not been reported.miRNAs are a group of endogenous noncoding small RNAs in vivo that regulate gene expression at the post-transcriptional level and are highly conserved and specific.Studies have shown that miRNAs participate in the occurrence and maintenance of atrial fibrillation by regulating genes involved in electrical remodeling or structural remodeling of the atrium.miRNA-1,miRNA-206 and miRNA-328 are involved in the regulation of the expression of related genes in ion channels.miRNA-21,miRNA-133 and miRNA-150 are involved in the regulation of genes involved in atrial fibrosis,both of them are associated with atrial fibrillation.The occurrence of the maintenance has a clear correlation.At present,it has been found that circulating miRNAs can be stably present in plasma and can be detected by means of qRT-PCR.Some studies have confirmed that miRNA-21,miRNA-328 and miRNA-150 are differentially expressed in plasma of patients with atrial fibrillation.This study attempted to comprehensively analyze the clinical baseline data,plasma biochemical parameters and circulating miRNAs in patients with atrial fibrillation,and to find the relevant risk factors for predicting recurrence after RFCA,and provide a clinical reference for improving the ablation efficiency of atrial fibrillation.Methods and Methods1.Select subjects and collect clinical data and biochemical markersFrom Sep.2014 to May.2016,100 patients with no atrial fibrillation were enrolled in the Qianfoshan Hospital affiliated to Shandong University as a control group.In the same period,270 patients with atrial fibrillation were enrolled in the Department of Cardiology,Qianfoshan Hospital Affiliated to Shandong University,and Department of Cardiology,Provincial Hospital of Shandong University.Collecting preoperative general clinical data of patients(such as:type of atrial fibrillation,duration of disease,smoking,history of hypertension,history of diabetes,left anterior and posterior diameter,left ventricular ejection fraction,etc.).The patients were collected for fasting venous blood and tested for biochemical markers(including liver function,renal function,glycosylated hemoglobin,etc.).2.miRNA detection2.1 Extraction of miRNAThe venous blood was collected from the EDTA anticoagulation tube in the fasting state of the patient,and the plasma was prepared by centrifugation at 4℃within 2 hours.The miRNA was extracted according to the QIAGEN miRNeasy Serum/Plasma Kit(Germeny Duesseldorf)instructions.2.2 Reverse transcription into cDNA and real-time PCR The cDNA was synthesized by reverse transcription using the tail method of GeneCopoeia All-In-OneTM miRNA qRT-PCR Detection Kit(USA).Real-time quantitative PCR was used to detect the amount of miRNA expression in the plasma of patients.3.Radiofrequency ablation treatmentAccording to the patient’s clinical diagnosis and intraoperative conditions.,the patient was subjected to radiofrequency ablation until the end of the ablation;if the ablation end point was not achieved,the cardioversion was performed to restore the sinus rhythm.4.Postoperative follow-up and groupingThree months after the operation,the patient was followed up regularly,and after 3 months,the patient was followed up by telephone or clinic.The follow-up time was 12 months.According to the recurrence of atrial fibrillation,the patients were divided into the postoperative recurrence group and non-postoperative recurrence group.According to the type of atrial fibrillation,patients with paroxysmal atrial fibrillation were divided into paroxysmal atrial fibrillation recurrence and non-recurrence subgroups;and patients with persistent atrial fibrillation were divided into persistent atrial fibrillation recurrence and non-recurrent subgroups.Results1.Single factor analysis of each group of clinical baseline dataCompared with postoperative recurrence group and postoperative non-recurrence group,we found atrial fibrillation type,intraoperative cardioversion,duration of disease,CHADS2 score,left atrial anterior diameter(LAD),left ventricular ejection fraction,uric acid,the difference in expression of plasma miRNA-21 in postoperative recurrence group was statistically significant(P<0.05).In the paroxysmal atrial fibrillation subgroup analysis,there was a statistically significant difference in LAD,LVEF,intraoperative cardioversion,and uric acid between the recurrence of paroxysmal atrial fibrillation and the non-recurring subgroup(P<0.05).And in the persistent atrial fibrillation subgroup,there was a statistically significant difference in duration of duration,LAD,uric acid between subgroups of persistent atrial fibrillation and the non-recurring subgroup(P<0.05).2.Single factor analysis of plasma miRNA expressionCompared with the control group,the expression levels of plasma miRNA-21,miRNA-206 and miRNA-328 in the atrial fibrillation group were up-regulated,while the expression levels of miRNA-150 and miRNA-133 were down-regulated,and the differences were statistically significant(P<0.05).Between postoperative non-recurrence group and postoperative recurrence group,the expression of plasma miRNA-21 were up-regulated in the recurrence group a(P<0.05).In the subgroup analysis,only the expression levels of plasma miRNA-21 had a statistically significant difference in the recurrence subgroup of paroxysmal atrial fibrillation.Compared with the non-recurrence subgroup and the non-recurrence subgroup of persistent atrial fibrillation,there was a statistically significant difference in the expression of plasma miRNA-21(P<0.05).3.Logistic regression analysisIn paroxysmal atrial fibrillation subgroup,LAD(OR= 1.187,P=0.031)and the expression levels of plasma miRNA-21(OR=1.226,P=0.012)in paroxysmal atrial fibrillation were statistically sigrnificant between the recurrence and non-recurrence subgroups.In persistent atrial fibrillation,LAD(OR = 1.125,P = 0.035),duration of disease(OR = 1.023,P = 0.019),plasma miRNA-21 expression(OR = 1.177,P =0.032)had differences between subgroups.Statistical significance.4.Area under the ROC curve(AUC)In the paroxysmal atrial fibrillation,the area under the ROC curve(AUC)was calculated as 0.750.After comprehensive calculation the expression of miRNA-21 in plasma and LAD,AUC=0.844;in persistent atrial fibrillation,comprehensive calculation LAD,duration of disease,and the expression of miRNA-21 in plasma the AUC of expression has a certain reference value.Conclusions1.The experiment found that different types of atrial fibrillation have different recurrence risk factors affecting recurrence after RPCA.2.The experimental results show that LAD and the expression of miRNA-21 in plasma are independent risk factors for predicting recurrence after RFCA in patients with paroxysmal atrial fibrillation.3.Experimental results show that LAD,duration of disease and the expression of miRNA-21 in plasma are independent risk factors for predicting recurrence after RFCA in patients with persistent disease. |
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