Published online before print January 19, 2004, doi: 10.1161/01.CIR.0000109495.02213.52
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(Circulation. 2004;109:363-368.)
© 2004 American Heart Association, Inc.
Clinical Investigation and Reports |
Atrial Extracellular Matrix Remodeling and the Maintenance of Atrial Fibrillation
From the Department of Medicine, Division of Cardiology (J.X., G.C., L.S.) and Department of Surgery, Division of Cardiothoracic Surgery (G.C., F.E., M.P., D.M., A.A., J.O., H.L., L.S.), David Geffen School of Medicine at University of California Los Angeles, Los Angeles, Calif.
Correspondence to Luyi Sen, MD, Division of Cardiology, UCLA Medical Center, 10833 Le Conte Ave, 47-123 CHS, Los Angeles, CA 90095-1679. E-mail lsen{at}mednet.ucla.edu
Received August 1, 2003; revision received October 17, 2003; accepted October 20, 2003
Background— Remodeling occurs in both ventricle and atrium in dilated cardiomyopathy and heart failure. However, the alteration of atrial extracellular matrix components during remodeling and its effect on the electrical remodeling and atrial arrhythmia have never been explored.
Methods and Results— Atrial tissue samples of 53 explanted hearts from patients with dilated cardiomyopathy and end-stage heart failure who underwent heart transplantation were examined. Nineteen patients had permanent atrial fibrillation (PmAF), 18 had persistent AF (PsAF), and 16 had no documented AF (NAF). Sixteen donor left atria (LA) were used as controls (CNs). Western Blot analysis revealed a selective downregulation of tissue inhibitor of metalloproteinase (TIMP)-2 in PmAF and PsAF groups compared with the NAF and CN groups and an upregulation of atrial metalloproteinase (MMP)-2 that was most pronounced in the PmAF group followed by the PsAF and NAF groups. Immunofluorescent staining revealed that in the LA, type I collagen volume fraction (CVF-I) increased significantly in the PmAF group followed by the PsAF and NAF groups compared with that in CN. LA CVF-I significantly correlated with LA dimension and TIMP-2 to MMP-2 ratio. In the PsAF group, CVF-I/CVF-III ratio was significantly correlated with AF duration and the frequency of AF recurrence.
Conclusions— Atrial extracellular matrix remodeling manifested by the selective downregulation of TIMP-2 along with upregulation of MMP-2 and CVF-I in the atrium is associated with the development of sustained atrial fibrillation in patients with cardiomyopathy and heart failure.
Key Words: fibrillation • metalloproteinases • heart failure • atrium • collagen
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