The Levels Of Matrix Metalloproteinases And Their Tissue Inhibitors In Atrial Fibrillation:Meta-Analysis

BackgroundAtrial fibrillation is the most common clinical arrhythmia and the major cause of atrial remodeling. In the cardiovascular system, the remodeling of the extracellular matrix is controlled by the matrix metalloproteinases (MMPs) and their tissue inhibitors (TIMPs). The aim of this systematic review and meta-analysis is to elucidate the behavior of plasma MMPs and TIMPs levels in Atrial Fibrillation and their relationship to atrial remodeling. Meanwhile, a variety of studies have evaluated whether MMPs and TIMPs levels have an association with AF recurrence after cardioversion or catheter ablation. Our another aim is to find the best candidate as biomarkers of atrial fibrillation that can predict the occurrence of atrial fibrillation and evaluate the treatment results of cardioversion and catheter ablation.MethodsPubmed, Cochrane Library, OvidSp, and Web of Science were searched updated to May,2014. Studies that provided values of plasma MMPs and TIMPs in AF patients using ELISA or immunoassay methods were considered eligible. Standardized mean difference (SMD), weighted mean difference (WMD) and 95% confidence interval (CI) were calculated to evaluate the association. Statistical analysis was performed with Stata 11.0.Results(Ⅰ) Plasma levels of MMPs and TIMPs in AF and sinus rhythm.Significant association between MMP-9 concentration and AF was observed. The SMD in the MMP-9 levels between the AF patients and sinus rhythm controls was2.86 units (95% CI:1.22,4.51; I2=97.8%).According to the features of atrial fibrillation, AF was classified into paroxysmal, persistent and permanent AF. In subgroup analysis,3 studies provided plasma MMP-9 levels in paroxysmal AF(SMD=3.15; 95%CI:-0.24,6.54; I2=98.1%).3 studies provided plasma MMP-9 levels in persistent AF (SMD=4.91; 95%CI:3.71,6.10; I2=69.2%).2 studies provided plasma MMP-9 levels in permanent AF (SMD=6.67; 95%CI:1.06,12.28; I2=96.9%).(Ⅱ)There were no significant association between pre-cardioversion plasma levels of MMPs, TIMPs and AF recurrence.(Ⅲ)Pre-ablation plasma levels of MMPs and TIMPs in AF recurrence or nonrecurrenceThere was significant positive association between MMP-2 concentration and AF recurrence. The WMD in the MMP-2 levels between the patients with and those without AF recurrence was 128.36 units (95% CI:40.85,215.87; I2=70.2%). There was significant positive association between TIMP-2 concentration and AF recurrence. The WMD in the TIMP-2 levels between the patients with AF recurrence and those without AF recurrence was 15.32 units (95% CI:4.07,25.57; I2=0.0%). The heterogeneity among studies was large.Conclusions:The results suggested that MMP-9 may serve as a biomarker of atrial remodeling in atrial fibrillation. MMP-2 and TIMP-2 could help the operators to evaluate the risk of AF recurrence after ablation and choose the suitable patients. The predictive value of MMPs and TIMPs in AF recurrence after cardioversion was still uncertain. Our results needed to be further confirmed in prospective clinical studies, hoping to provide new tools to estimate the occurrence, development and recurrence risk of atrial fibrillation.BackgroundTo explore the correlation between myocardial MMPs and TIMPs mRNA levels and Chinese with atrial fibrillation (AF).MethodsDatabases including Pubmed, Web of Science, CNKI and Wanfang databases were searched up to May,2014, to retrieve published studies comparing myocardial mRNA levels of MMPs and TIMPs in Chinese AF patients and sinus rhythm (SR) patients, and a meta-analysis was conducted. The cardiac tissue samples were obtained from patients who underwent cardiac surgery.ResultsAltogether 9 studies with AF patients and SR controls were included.The MMP-1 mRNA expression was higher in AF patients than in controls (SMD=0.48,95%CI 0.20～0.76, P<0.01). The MMP-9 mRNA expression was higher in AF patients than in controls (SMD=1.11,95% CI 0.75～1.46, P<0.01). There was no significant difference in the TIMP-1 and TIMP-2 mRNA expressions between AF patients and controls (SMD=-0.56,95% CI-1.77～0.65, P=0.37) (SMD=0.31,95% CI: -1.16～1.78, P=0.68).ConclusionsAtrial fibrosis increases in atrial fibrillation, and the increased transcript levels of MMP-1 and MMP-9 are associated with the occurrence of atrial fibrillation and remodeling of atrial structure. However, the role of TIMPs is still unclear.BackgroundWith the development of people’s living standard and the gradual change in lifestyles, coronary artery disease is tremendously increasing, which has become the top contributor to death and disability. CAD is a multifactorial disease involving complex interactions between genetic and environmental factors. The genetic susceptibility has been considered playing an important role in the development of CAD. Recently, the single nucleotide polymorphism (SNP) has attracted more attention, and identification of the candidate gene susceptibility to CAD has been a scientific focus.The GNB3 C825T gene polymorphism caused enhanced G protein activation and increased proliferation of vitro cell. Many researchers have shown the associations between the GNB3825T allele and diseases such as hypertension, metabolic syndrome, and stroke. Several epidemiological studies have evaluated the association between the C825T polymorphism and coronary artery disease (CAD), but the results were inconsistent so that a meta-analysis was performed to clarify these discrepancies.ObjectiveTo explore the association between GNB3 gene C825T polymorphism and risk of CAD by performing a meta-analysis based on published articles.MethodsWe systematically searched the PubMed, Web of Science, Medline, Elsevier Science Direct, Cochrane Library, and Wanfang databases. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated in allelic, dominant, recessive, and co-dominant models. Subgroup and sensitivity analyses were performed to detect study heterogeneity and examine result stability. Publication bias was tested using the Egger’s regression test, and Begg’s funnel plots.ResultsWe screened 9 case-control studies regarding CAD (5,955 cases and 5,162 controls). No significant associations between C825T polymorphism and CAD risk was observed in the overall population, except for the co-dominant model of TT vs. CC (allelic model:T vs. C, OR=1.10,95% CI=[0.999,1.202]; dominant model: TT+TC vs. CC, OR=1.03,95% CI= [0.94,1.12]; and recessive model:TT vs. CT+CC, OR=1.05,95% CI= [0.81,1.35]; co-dominant model TT vs. CC, OR=1.17, 95%CI= [1.01,1.35]; CT vs.CC, OR=1.08,95%CI=[0.99,1.18]).ConclusionThe GNB3 C825T polymorphism may not be a major contributor to the CAD risk.AimThe purpose of this case report is to improve the clinical understanding of Loffler endocarditis pathogenesis, clinical manifestations, diagnosis, treatment and prognosis.MethodWe reported a case of Loffler endocarditis, recording his clinical manifestations and treatment through long-term follow-up study.ConclusionLoffler endocarditis along with a persistent eosinophilia in peripheral blood(> 1.5 x 109/L) can impair the endocardium, thus causing cardiac systolic dysfunction. More attention should be paid to the cardiac impairment via early diagnosis and treatment. Bone marrow examination, echocardiography, MRI, and endomyocardial biopsy are effective diagnostic methods. Patients’prognosis will be obviously improved by use of hydroxyurea, corticosteroids, glivec.