Preoperative serum soluble receptor activator of nuclear factor-κB ligand and osteoprotegerin predict postoperative atrial fibrillation in patients undergoing cardiac valve surgery.
Preoperative serum soluble receptor activator of nuclear factor-κB ligand and osteoprotegerin predict postoperative atrial fibrillation in patients undergoing cardiac valve surgery.
复制标题
术前血清可溶性核因子κB配体受体激活剂和骨保护素可预测接受心脏瓣膜手术的患者术后心房颤动。
DOI：
10.1016/j.athoracsur.2013.04.042
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发表时间：
2013
期刊：
影响因子：
--
通讯作者：
Dongjin Wang
中科院分区：
文献类型：
--
作者：
H. Cao;Qing Zhou;Yanhu Wu;Qingguo Li;O. Røe;Yijiang Chen;Zhong Wu;Dongjin Wang
研究背景术后心房颤动（postoperative atrial fibrillation，POAF）是心脏手术后常见的并发症，可导致严重的并发症和住院时间延长.循环骨保护素浓度与房颤发生率之间存在显著相关性。骨保护素/核因子-κ B受体激活剂/核因子-κB配体（RANKL）受体激活剂轴也可能参与AF的发生和进展。骨保护素比率与心脏手术患者POAF的发生率相关。方法我们纳入了154例术前窦性心律的患者，瓣膜手术术前采集静脉血，测定血清可溶性RANKL和骨保护素。POAF定义为放电前持续至少30秒的特征性心律失常。结果房颤组血清可溶性RANKL和骨保护素水平及可溶性RANKL/骨保护素比值均显著高于窦性心律组。在多变量生存回归分析中，C反应蛋白、射血分数、左心房和右心房直径、术前使用β受体阻滞剂、通气持续时间，特别是血清可溶性RANKL水平和可溶性RANKL/骨保护素比值独立预测POAF。根据受试者工作特征曲线分析，血清可溶性RANKL水平和可溶性RANKL/骨保护素比值预测POAF的最佳阈值分别为3.62 pmol/L和0.51。结论术前血清可溶性RANKL水平和可溶性RANKL/骨保护素比值升高是心脏瓣膜手术后POAF的独立预测因子。这些发现对于识别POAF风险较高的患者，可以考虑进行预防性治疗具有重要意义。
BackgroundPostoperative atrial fibrillation (POAF), a frequent complication after cardiac surgery, causes morbidity and prolongs hospitalization. A significant association between circulating osteoprotegerin concentration and atrial fibrillation incidence had been identified. Osteoprotegerin/receptor activator of nuclear factor-κB/receptor activator of nuclear factor-κB ligand (RANKL) axis may also contribute to the development and progression of AF. Herein we sought to determine whether preoperative serum soluble RANKL and osteoprotegerin and soluble RANKL/osteoprotegerin ratio are associated with the incidence of POAF in cardiac surgery patients.MethodsWe enrolled 154 patients with preoperative sinus rhythm undergoing isolated cardiac valve surgery. Preoperative venous blood samples were obtained for measurement of serum soluble RANKL and osteoprotegerin. The POAF was defined as the characteristic arrhythmia lasting for at least 30 seconds before discharge. Comparison was made between patients without episode of POAF (sinus rhythm group, n = 93) and patients experiencing POAF (atrial fibrillation group, n = 61).ResultsSerum levels of soluble RANKL and osteoprotegerin and soluble RANKL/osteoprotegerin ratio were significantly higher in the atrial fibrillation group than the sinus rhythm group. In multivariate survival regression, C-reactive protein, ejection fraction, left and right atrial diameters, preoperative use of beta-blocker, duration of ventilation, particularly serum soluble RANKL level, and soluble RANKL/osteoprotegerin ratio independently predicted POAF. According to receiver operating characteristic curve analysis, the best threshold values of serum soluble RANKL level and soluble RANKL/osteoprotegerin ratio for predicting POAF were 3.62 pmol/L and 0.51, respectively.ConclusionsElevated preoperative serum soluble RANKL level and soluble RANKL/osteoprotegerin ratio are independent predictors for POAF in patients undergoing cardiac valve surgery. These findings have important implications for identifying patients at higher risk of POAF who could be considered for prophylactic therapy.