| Objective: The specific mechanism of atrial fibrillation combined with heart failure is still unknown.The GWAS study jointly conducted by Sonia Shah et al.identified 12 independent variants associated with heart failure at 11 genomic loci,among which 3 SNPs were associated with atrial fibrillation.Is it possible to stratify patients with atrial fibrillation and heart failure through genomics based on these 3 known sites,and screen suitable patients to receive appropriate treatment to achieve a better prognosis.Materials and Method:(1)The study continuously included 281 patients with atrial fibrillation complicated with systolic heart failure(LVEF<50%)diagnosed and treated in the First Affiliated Hospital of Dalian Medical University from February 2017 to May 2021 Collect the sex,age,past history,type of atrial fibrillation,treatment of atrial fibrillation,left ventricular ejection fraction(LVEF),left atrial diameter(LAD),left ventricular internal diameter(LVD)in echocardiography,and follow-up LVEF status,heart failure rehospitalization events,and all-cause death events;the definition of LVEF recovery includes the following: 1.LVEF decrease at baseline ≤40%;absolute improvement of LVEF exceeds 10%,and the second measurement of LVEF exceeds 40%.2.LVEF decreased by 41-49% at baseline,and LVEF≥50%in the second measurement.(3)Process the collected blood samples.DNA extraction,PCR amplification,purification,sequencing and typing of loci rs17042102,rs4746140 and rs11745324 using Sanger next-generation sequencing.(4)The software SPSS 26.00 was used for data analysis.Results:(1)A total of 281 patients were included in this study,followed up for 1 year,and the average age was 30% female.There were 195 patients(69.4%)with recovery of left ventricular ejection fraction,classified into the recovery group,with an average age of 70 years,and 32% were female.The remaining 86 patients were classified into the non-recovery group,with an average age of 70.4 years,and 24% were female.Mean LVEF in the recovery group improved from 38% to 51%(p<0.001).The mean LVEF of the nonrecovery group did not differ before and after treatment.Univariate analysis showed that the type of atrial fibrillation(p=0.019),treatment method(p<0.001),LVEF level before treatment(p<0.001),and left atrial diameter(p<0.012)were related to the recovery of LVEF.There were statistically significant differences in rehospitalization rate and mortality between LVEF recovery group and non-recovery group(p<0.001).(2)In the recovery group,there were 51 patients carrying locus rs17042102 and typed as GG wild type,accounting for 80% of the overall GG genotype,and 87 patients carrying variant heterozygote GA,accounting for 64% of the overall genotype.There were 57 cases carrying variant homozygous AA,accounting for 64% of the overall genotype.The distribution frequency of allele G in the recovery group accounted for 0.47,and the frequency of risk allele A was 0.53.The frequencies of allele G and A in the non-recovery group were 0.46 and 0.54,respectively.There was no difference in the distribution of risk alleles between the two groups.(3)The risk allele of rs17042102 is A.under the dominant genetic mode,wild-type GG,that is,patients without risk gene,has a better recovery of LVEF after treatment than patients with at least one risk gene(OR:1.99,95%CI:1.02-3.89 pause 0.042).The variant heterozygote with one risk gene in the additive model is more beneficial to the recovery of LVEF than the variant homozygote with two risk genes.A multivariate analysis model was established for the two genetic models of rs17042102,including SNP,type of atrial fibrillation,treatment,LVEF and LAD.Except for the effects of several clinical factors on the results of LVEF,patients with rs17042102 without risk gene in dominant mode had better recovery of LVEF after treatment.(OR: 2.25,95% CI: 1.05-4.83,p=0.037).Conclusion:(1)Regardless of the influence of genetic factors,the preferred rhythm intervention therapy for patients with heart failure with atrial fibrillation and impaired ejection fraction is more beneficial to the patients.(2)Patients with the same phenotype are not the same disease at the genetic level.Although the expression of PITX2 gene is low in the left ventricle,it may affect the function of the left ventricle in some way,which requires further functional verification.Genetic factors are involved in the process of heart failure caused by atrial fibrillation,and the patients with atrial fibrillation combined with heart failure are stratified on this basis.Patients who do not carry the risk site of this SNP are more likely to have AIC,and a better prognosis can be achieved through active treatment. |
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