Role of serum TGF-β1 level in atrial fibrosis and outcome after catheter ablation for paroxysmal atrial fibrillation

Abstract

This study aimed to evaluate the relationship between serum transforming growth factor-β1 (TGF-β1) concentration and atrial fibrosis and to determine whether plasma TGF-β1 concentration is an independent predictor of atrial fibrillation (AF) recurrence after catheter ablation.We included 98 consecutive patients who underwent catheter ablation, including 38 with paroxysmal AF (AF group) and 60 with paroxysmal supraventricular tachycardia (control group). We compared their preablation serum concentration of biomarkers and clinical and echocardiographic findings.Serum TGF-β1 concentrations, type-III procollagen N-terminal peptides (PIIINP), type-IV procollagen (IV-C), and laminin (LN) were significantly higher in the AF group than in the control group; however, there was no correlation between their concentrations and left atrial diameter (LAD). The area of the low-voltage zone positively correlated with TGF-β1 and PIIINP concentrations, but not with LAD. Atrial tachyarrhythmia (AF and AFL/AT) recurrence was observed in 15 patients (39.4%) at mean 241.4 ± 68.5 days of follow-up 12 months after ablation. Regression analysis revealed that TGF-β1 was a major risk factor for AF recurrence (odds ratio, 1.14; 95% confidence interval, 1.11–1.17; P = .02).Serum TGF-β1 concentration is an independent predictor of AF recurrence in patients with paroxysmal AF and may help identify patients likely to have better outcomes after catheter ablation.

Atrial Myopathy Underlying Atrial Fibrillation

“…Serum TGF-beta1, which was previously discussed as part of the fibrotic pathway, has a strong positive correlation with areas of low endocardial atrial voltage consistent with fibrosis (r[ 2 ]=0.93; p<0.001). [ 93 ] In addition, TGFbeta1 expression is specifically upregulated in patients with extensive low-voltage areas undergoing ablation. [ 94 ] Serum TGF-beta1 has been shown to be an independent risk factor for AF recurrence after ablation in both paroxysmal and persistent AF.…”

“…[ 94 ] Serum TGF-beta1 has been shown to be an independent risk factor for AF recurrence after ablation in both paroxysmal and persistent AF. [ 93 , 95 ] Interestingly, Kishima et al found lower concentrations of TGF-beta1 in patients with recurrence after ablation. [ 96 ] They suggested that the discrepancy may be related to the inflammatory state of the patient.…”

Immunopathogenesis and biomarkers of recurrent atrial fibrillation following ablation therapy in patients with preexisting atrial fibrillation

“…Several prospective studies in human subjects have implicated TGF-β1 as an independent predictor of RAF following ablation therapy. [70][71][72][73][74][75] Additionally, a study by Cao et al 76 demonstrated that polymorphisms in TGF-β1 gene promotors may be useful in predicting the prognosis of patients in Chinese populations following ablative therapy for AF. Similar to TGF-β1, matrix metalloproteinases (MMPs) and tissue inhibitor of metalloproteinases (TIMPs) have been associated with AF, due to their role in ECM metabolism.…”

“…However, no significant correlation was reported in 154 patients with paroxysmal AF. 74 Tian et al 70 found that serum TGF-β1 concentrations prior to catheter ablation were predictive of RAF in a group of 38 patients with paroxysmal AF. 70 The findings of these two studies indicate a potential role of TGF-β1 to predict RAF.…”

Thrombospondin-2

“…For instance, atrial fibrotic remodeling was reported to be associated with the development and persistence of atrial fibrillation (AF). 16,17) And adipose tissue fibrosis was reported to be a major contributor to insulin resistance in obesity. 18) However, the association between circulating TSP2 levels and the prevalence of AF or insulin resistance remains to be investigated in the general population.…”