Systemic vascular cell adhesion molecule-1 predicts the occurrence of post-operative atrial fibrillation

• Published in: International journal of cardiology 2011-08, Vol.150 (3), p.270-276
• Main Authors: Verdejo, Hugo, Roldan, Juan, Garcia, Lorena, del Campo, Andrea, Becerra, Elia, Chiong, Mario, Mellado, Rosemarie, Garcia, Amalia, Zalaquett, Ricardo, Braun, Sandra, Garayar, Bernardita, Gonzalez, Sergio, Lavandero, Sergio, Corbalan, Ramon
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Atrial fibrillation; Atrial Fibrillation - blood; Atrial Fibrillation - diagnosis; Atrial Fibrillation - etiology; Biological and medical sciences; Biomarkers - blood; Cardiac dysrhythmias; Cardiology. Vascular system; Cardiovascular; Coronary Artery Bypass - adverse effects; Coronary artery bypass surgery; Coronary heart disease; Female; Heart; Humans; Male; Medical sciences; Middle Aged; Postoperative Complications - blood; Postoperative Complications - diagnosis; Postoperative Complications - etiology; Predictive Value of Tests; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Thrombomodulin; Vascular Cell Adhesion Molecule-1 - blood; VCAM-1
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2010.04.033

Abstract Background Post-operative atrial fibrillation occurs in 30% of patients after on-pump heart surgery and is associated to elevated inflammatory markers. We have evaluated if the systemic biomarkers of inflammation and endothelial damage, vascular cell adhesion molecule-1 (VCAM-1) and soluble thrombomodulin may help in identifying patients prone to development of post-operative atrial fibrillation. Methods One hundred and forty-four patients in sinus rhythm submitted to elective coronary artery bypass surgery. Systemic inflammatory, oxidative stress and endothelial damage markers were measured at baseline and 72 h after surgery. During the procedure, a sample of the right atrial appendage was obtained for histochemistry. Electrocardiogram was monitored for 72 h after surgery for event adjudication. Results 22% of the patients developed post-operative atrial fibrillation. Baseline systemic inflammatory markers did not differ between patients with or without post-operative atrial fibrillation. However, baseline plasma VCAM-1 and thrombomodulin levels were significantly higher in patients who developed post-operative atrial fibrillation. After adjustment for age, gender, comorbidities and concurrent medication, circulating VCAM-1 remained as an independent predictor for post-operative atrial fibrillation development. No association was observed between systemic plasma VCAM-1 and VCAM-1 tissue expression in the right atrial appendage. Conclusions In patients undergoing coronary artery bypass surgery, elevated VCAM-1 levels predict a higher risk for post-operative atrial fibrillation. Plasma VCAM-1 elevation is not related to its expression in the right atria, suggesting that systemic endothelial damage rather than local changes pre-exist in patients who develop the arrhythmia.