| Objective:To determine the expression of the transforming growth factor-beta 1(TGF-β1) and the collagen type I and type III volume fraction in patients with rheumatic heart disease(RHD) and permanent atrial fibrillation(PAF) and to investigate the relationship of the expression of TGF-β1and the effectiveness of radiofrequency MAZE procedure in patients with RHD and PAF, and to provide more profound theoretical basis and experimental evidence for the future surgical treatment of PAF.Methods:A total of 40 patients with RHD and PAF who underwent radiofrequency MAZE procedure with concomitant valvular surgery were collected in strict accordance with the selection and exclusion criteria for the experimental group. We followed up these patients after 3 and 6 months after surgery. And we assigned these patients to non-AF group and AF recurred group according to the results of the 6-month follow-up. Another 10 patients with RHD and SR who underwent valvular surgery alone were assigned to sinus rhythm (SR) control group. Left atrial appendages were obtained in all patients. The mRNA and protein expression of TGFβ1 were detected by semiquantitative RT-PCR and Western-blot technique respectively; the collagen volume Fraction I, III (CVF-I,CVF-III) were observed by picrosirius polarization method method.Results:Each group has the consistent clinical baseline. At 6-month follow-up, there were 28 patients in non-AF group and 12 in AF group. (1) The mRNA and protein expression of TGFβ1, CVF-I and CVF-I/CVF-III in control group, non-AF group and AF recurred groups were increased gradually (F=6.487,P=0.003; F=6.499, P=0.004; F=3.711, P=0.032; F=3.697,P=0.032). But the CVF-III have no significant changes among the three groups (P>0.05). (2) The patients who had return of functional atrial contraction in non-AF group had lower mRNA and protein expression than the non-return patients(t=5.570,P=0.027;t=3.505,P=0.004). (3) The mRNA and protein expressions of TGFβl were positively correlated with CVF-I (r=0.786, P<0.05; r=0.745, p<0.001, respectively) and left atrial dimension (r=0.858, P<0.05; r=0.765, p<0.001, respectively). (4) Univariate logistic regression analysis revealed that the expression levels of TGF-β1mRNA (OR:1.13,95%CI1.05-1.18,p=0.031), protein (OR=1.069, 95%CI 1.004-1.13, p=0.037), CVF-I (OR:1.069,95%CI1.004-1.13,P=0.037)and left atrial diameter (OR:2.23,95% CI1.08-4.59, p=0.042) were associated with the postoperative persistence of atrial fibrillation at 6-month follow-up. However, in multivariate logistic regression analysis, no independent predictor of recurrent AF after 6 month's follow-up was identified.Conclusions:1. The mRNA and protein expression of TGFβ1 was positively correlated with the left atrial dimension and the degree of fibrosis and may be related to the efficacy and resumption of the atrial function after AF surgical radiofrequency ablation.2. Higher expression of TGF-β1 mRNA was related with a lower rate of sinus rhythm restoration and vice versa. |
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