Matrix Metalloproteinase Neutrophil Gelatinase-Associated Lipocalin Complex Predicts Atrial Fibrillation Recurrence after Electrical Cardioversion in Obese Patients

Abstract

Background: There is not much data on matrix metalloproteinase neutrophil gelatinase-associated lipocalin (MMP-NGAL) complex in patients with atrial fibrillation (AF). Aim: The aim of the study was to assess the value of MMP-NGAL complex in predicting AF recurrence after electrical cardioversion. Methods: The serum levels of NGAL, cystatin C, interleukin-6, high-sensitivity C-reactive protein, copeptin, MMP-NGAL complex, matrix metalloproteinase 2, tissue inhibitor of metalloproteinase 1, Von Willebrand factor, B-type natriuretic peptide and the urinary level of NGAL were evaluated before cardioversion. Results: A total of 83 patients with persistent AF were enrolled in the study. Left atrial diameter (LA) ≥4.5 cm was significantly associated with AF recurrence at follow-up (p = 0.009). In selected 39 obese patients, MMP-NGAL complex was associated with AF recurrence (p = 0.03). If the concentration of MMP-NGAL complex increased by 1 ng/ml, the odds of AF recurrence increased by 4% (OR 1.04; CI: 1.00-1.08; p = 0.03). MMP-NGAL complex did not correlate with AF recurrence in patients with a first episode of AF, in patients ≥65 years of age and in patients with a LA ≥4.5 cm or with chronic kidney disease. Conclusions: It is known that the greater the BMI at baseline, the higher the likelihood of progression from paroxysmal to permanent AF. However, European Society of Cardiology (ESC) guidelines do not consider obese patients a population with a low likelihood of success of cardioversion. That is why we need a sensitive marker to predict sinus rhythm maintenance in such a population. We found that MMP-NGAL complex may predict AF recurrence after successful cardioversion in obese patients.

DACT1 Involvement in the Cytoskeletal Arrangement of Cardiomyocytes in Atrial Fibrillation by Regulating Cx43

“…Moreover, the force transmission can be directly or indirectly mediated by the focal proteins on the cytoskeleton [4] . Acute mechanical changes produce electrophysiological alterations and arrhythmias, mediated by both the cytoskeleton and the extracellular matrix [4-6] . Once AF is induced, rapidly and inhomogeneously contracting and interacting atrial segments would tend to perpetuate electrophysiological dispersion [4] , which could facilitate the geometry (fibrosis and scarring of atrium) formation [7] .…”

Pre-procedural high serum visfatin and tumor necrosis factor-α might predict recurrent atrial fibrillation after catheter ablation

“…Patients who developed RAF were significantly older and had significantly larger LAD and RAF incidence that was significantly related to both variables. Similarly, Mlodawska et al [ 30 ] reported that LAD ≥ 4.5 cm was significantly associated with RAF at follow-up and Chang et al [ 31 ] detected that persistent AF and LAD are independently predicted recurrent atrial arrhythmia after ablation.…”

“…These findings indicated a possible role for obesity in induction and/or recurrence of AF and supported earlier studies that documented prediction of higher recurrence after CA for non-paroxysmal AF patients with metabolic syndrome [ 32 ], and that hypertension, obesity, and long-standing persistent AF were associated with very-late RAF [ 33 ]. Also, Mlodawska et al [ 30 ] had reported that the greater the BMI at baseline, the higher the likelihood of progression from paroxysmal to permanent AF, and Truong et al [ 34 ] detected significantly higher number of overweight patients among hypertensive patients with RAF.…”

“…By the assumption that obesity is an important constitutional factor for induction, progression, or recurrence of AF, the current results showed significantly higher serum levels of studied adipocytokines; visfatin and adiponectin, and TNF-α in patients of RAF than in NO RAF groups. Moreover, the levels of these adipocytokines and studied primary phase reactants; CRP and IL-6 were positively correlated with LAD, which had previously been documented as an independent predictor for RAF [ 30 , 31 ].…”

Peculiarities of chronic heart failure formation in patients with persistent atrial fi brillation depending on the renal dysfunction phenotype

“…показало, что наличие постоянной формы ФП у пациентов с ХСН со сниженной ФВ ЛЖ характеризуется почечной дисфункцией с увеличением концентрации NGAL в крови и является независимым фактором неблагоприятного клинического исхода [11]. Более того, NGAL в сочетании с повышенной концентрацией матриксных металлопротеиназ в крови является предиктором рецидивов пароксизмов ФП после электрической кардиоверсии у тучных больных [12].…”