Atrial matrix remodeling in atrial fibrillation patients with aortic stenosis
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RESEARCH ARTICLE
Open Access
Atrial matrix remodeling in atrial fibrillation patients with aortic stenosis Mariana Fragão‑Marques1,2* , I. Miranda1, D. Martins1, I. Barroso2,4, C. Mendes1, A. Pereira‑Neves3, I. Falcão‑Pires1 and A. Leite‑Moreira1
Abstract Background: This study aimed to evaluate atrium extracellular matrix remodeling in atrial fibrillation (AF) patients with severe aortic stenosis, through histological fibrosis quantification and extracellular matrix gene expression analy‑ sis, as well as serum quantification of selected protein targets. Methods: A posthoc analysis of a prospective study was performed in a cohort of aortic stenosis patients. Between 2014 and 2019, 56 patients with severe aortic stenosis submitted to aortic valve replacement surgery in a tertiary hospital were selected. Results: Fibrosis was significantly increased in the AF group when compared to sinus rhythm (SR) patients (p = 0.024). Moreover, cardiomyocyte area was significantly higher in AF patients versus SR patients (p = 0.008). Conversely, collagen III gene expression was increased in AF patients (p = 0.038). TIMP1 was less expressed in the atria of AF patients. MMP16/TIMP4 ratio was significantly decreased in AF patients (p = 0.006). TIMP1 (p = 0.004) and TIMP2 (p = 0.012) were significantly increased in the serum of AF patients. Aortic valve maximum (p = 0.0159) and mean (p = 0.031) gradients demonstrated a negative association with serum TIMP1. Conclusions: Atrial fibrillation patients with severe aortic stenosis present increased atrial fibrosis and collagen type III synthesis, with extracellular matrix remodelling demonstrated by a decrease in the MMP16/TIMP4 ratio, along with an increased serum TIMP1 and TIMP2 proteins. Keywords: Atrial fibrillation, Aortic stenosis, Fibrosis, Atrial remodeling, Biomarkers Background Atrial fibrillation (AF) is the most common cardiac arrhythmia with adverse clinical outcomes and diverse pathophysiological background [1]. AF affects approximately 20.9 million men and 12.6 million women worldwide, representing a 1.5-fold and two-fold increase in all-cause mortality, respectively [2]. Aortic stenosis is the most prevalent valvular disease, with aortic valve replacement (AVR) surgery remaining *Correspondence: [email protected] 1 Cardiovascular Research and Development Center, Faculty of Medicine, University of Porto, Alameda Professor Hernani Monteiro, 4200 Porto, Portugal Full list of author information is available at the end of the article
the gold standard treatment for severe symptomatic aortic stenosis, improving both quality of life and overall survival [3]. Owing to ageing demographics, aortic stenosis has been increasing over the past decades, presenting an AF prevalence of 35.6% in a multicentre prospective registry of aortic stenosis patients [4, 5]. However, the pathophysiology of AF in aortic stenosis is poorly understood. AF pathophysiology begins with ectopic firing and re-entry, which depend on several mechanisms: (1) ion channel dysfunction; (2)
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