title: Intracardiac expression of markers of endothelial damage/dysfunction, inflammation, thrombosis, and tissue remodeling, and the development of postoperative atrial fibrillation.
abstract: BACKGROUND
  Atrial fibrillation (AF) is a common complication of coronary artery bypass grafting (CABG), and may have an inflammatory and/or thrombotic etiology. We sought to determine the expression of inflammatory (interleukin [IL]-6), thrombotic (tissue factor and von Willebrand factor [VWF]) and remodeling (matrix metalloproteinase [MMP]-9 and tissue inhibitor of metalloproteinase [TIMP]-1) markers by left atrial appendage (LAA) and right atrial appendage (RAA) tissue in the prediction of postoperative AF. We determined whether the tissue expression of markers of certain different pathophysiologic mechanisms predicted the development of AF after CABG.
  
  
  METHODS
  LAA and RAA tissue was excised during CABG in 100 patients free of AF and inflammation. Tissue marker expression was quantified by immunohistochemistry and was related to 30-day postoperative AF.
  
  
  RESULTS
  Overall, there were no significant differences in staining intensity of any marker between LAA tissue and RAA tissue. However, more intense expression of VWF by LAA tissue predicted the 30 patients with postoperative AF as compared with those free of AF (P = 0.006). IL-6, MMP-9 and TIMP-1 expression by RAA and LAA epicardial tissue was stronger than expression by endocardium or cardiomyocytes (all P < 0.025) but failed to predict AF.
  
  
  CONCLUSIONS
  In this study, one of the largest to investigate tissue expression of pathophysiologic markers in relation to postoperative AF, we show that more intense expression of VWF by LAA tissue is a significant predictor of postoperative AF. This points towards a possible role of endothelial damage/dysfunction (as reflected by VWF changes) in the pathogenesis of postoperative AF.
authors.affiliation: Haemostasis, Thrombosis, and Vascular Biology Unit, University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, UK.
authors.forename: D
authors.initials: D
authors.lastname: Kaireviciute
authors.forename: G Y H
authors.initials: GY
authors.lastname: Lip
authors.forename: B
authors.initials: B
authors.lastname: Balakrishnan
authors.forename: G
authors.initials: G
authors.lastname: Uzdavinys
authors.forename: G
authors.initials: G
authors.lastname: Norkunas
authors.forename: G
authors.initials: G
authors.lastname: Kalinauskas
authors.forename: V
authors.initials: V
authors.lastname: Sirvydis
authors.forename: A
authors.initials: A
authors.lastname: Aidietis
authors.forename: U
authors.initials: U
authors.lastname: Zanetto
authors.forename: H
authors.initials: H
authors.lastname: Sihota
authors.forename: M
authors.initials: M
authors.lastname: Maheshwari
authors.forename: A D
authors.initials: AD
authors.lastname: Blann
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000209:etiology / Q000378:metabolism*; D015415:Biomarkers / Q000378:metabolism*; D001026:Coronary Artery Bypass / Q000009:adverse effects; D004727:Endothelium / Q000378:metabolism*; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D007249:Inflammation / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000378:metabolism*; D011183:Postoperative Complications; D013927:Thrombosis / Q000378:metabolism*
chemical_list: D015415:Biomarkers