心房肌线粒体功能异常增加冠脉旁路移植术后新发房颤的风险

Myocardium Mitochondrial Dysfunction is Associated with the Risk of New Onset of Atrial Fibrillation after Coronary Artery Bypass Grafting Surgery

目的分析心房组织过氧化物酶体增殖物激活受体γ辅激活子1α(PGC-1α)水平与冠心病患者接受冠状动脉旁路移植(CABG)术后新发房颤(POAF)的相关性,并评估影响PGC-1α水平的风险因素。方法入选79例窦性心律且接受冠脉搭桥的冠心病患者。收集患者术前、术中和术后资料,在术中获取右心耳组织。POAF由心电图评定,而且必须有抗心律失常治疗。PGC-1α在心肌组织中的水平用ELISA方法测定。结果发生术后房颤的患者(n=22)的心房组织中,PGC-1α的蛋白和转录水平均显著低于术后维持窦性心律患者(P<0.05)。二元Logistic回归分析发现PGC-1α(OR 0.407[95%CI 0.191-0.850])、糖尿病(OR 1.608[95%CI 1.243–1.971])与POAF明显相关(P<0.05)。在多元线性回归模型中,低PGC-1α水平与糖尿病史显著相关(P<0.05)。结论心房肌组织PGC-1α水平低的患者术后新发房颤的风险显著增高。心房肌组织线粒体功能异常是导致CABG术后新发房颤的可能机制。

Objective To The goal of this study was to analyze the relationship between peroxisome proliferator-activated receptor gamma coactivator-1α（PGC-1α） and new onset of atrial fibrillation（AF） after isolated CABG surgery. Methods Right atrial appendages were obtained from 79 patients undergoing isolated coronary artery bypass grafting, who were in normal sinus rhythm pre-operatively. Those who exhibited new onset of post-operative atrial fibrillation（POAF）（n=22） or who remained in sinus rhythm（SR）（n=57） were prospectively matched based on preoperative, intraoperative, and postoperative characteristics. Postoperative atrial fibrillation was assessed by electrocardiogram and must have required initiation of antiarrhythmic therapy or anticoagulation. Local PGC-1α concentration was quantified by enzyme-linked immunosorbent assay（ELISA） in tissue homogenates. Results PGC-1α levels was significant reduced in POAF patients compared with SR patients（P〈0.05）. PGC-1α（OR 0.407 [95%CI 0.191-0.850]） and diabetes mellitus（OR 1.608 [95%CI 1.243–1.971]） were independently related with POAF（P〈0.05）. This reduction in PGC-1α was associated with presence of diabetes mellitus（DM）（P〈0.05）. Conclusions Patients who have low PGC-1α levels are in more risk of new-onset postoperative atrial fibrillation. The myofibrillar energetic impairment may be important in the pathogenesis of AF.