To investigate if an AF dependent dysbalance of the physiologically most important pro- and antithrombotic proteins, TF and TM respectively, exists in the atrial appendages.
ID
Source
Brief title
Condition
- Cardiac arrhythmias
- Embolism and thrombosis
Synonym
Research involving
Sponsors and support
Intervention
Outcome measures
Primary outcome
Degree of TM an TF expression and activity in the atrial appendages
Degree of CML-CEL expression in the atrial appendages
Secondary outcome
Serum CML-CEL values
Skin auto fluorescence values of AGEs
Viral presence in atrial appendages
Atrial appendage proteomics
AF score (representing the electrophysiological tissue properties)
Background summary
Rationale:
Atrial fibrillation (AF) is the most common arrhythmia of the Western world.
The true danger of AF lies in the increased ischemic stroke risk. Clinical
observations of ischemic strokes in low risk patients, ischemic strokes despite
oral anticoagulation and increased bleeding risk underline the need for an
improved understanding of the pathophysiologic mechanism of thrombus formation
in AF patients. The influence of one aspect of Virchow*s triad, endothelial
dysfunction, has been underexposed in this matter. With very little evidence at
hand, we want to analyze the atrial appendages using a broad range of tools. We
include studying the presence of so-called advanced glycation endproducts
(AGEs), considering their increasing popularity as important players in
cardiovascular disease, (cardiac)viruses as well as proteomics and mapping of
electrophysiological properties.
Hypotheses
1. AF is associated with atrial (appendage) endothelial changes favouring an
ischemic stroke, either by increasing pro-thrombotic protein expression,
decreasing anti-thrombotic protein expression or a combination of both.
2. AGEs are increased in the atrial appendages of AF patients and contribute to
the increased thromboembolic risk / hypercoagulable state
3. AGEs concentration relates to type of AF
Study objective
To investigate if an AF dependent dysbalance of the physiologically most
important pro- and antithrombotic proteins, TF and TM respectively, exists in
the atrial appendages.
Study design
Cross-sectional pilot study
Study burden and risks
The risks associated as well as the patients burden are kept to an absolute
minumum by, for instance, performing the transesophageal echocardiograms (TEE)
while the patient is anesthetised and sample blood during routine blood
drawings. The patient is exposed to the risks inherent to vena puncture.
Transthoracic echocardiography and skin autofluorescence measurement are almost
without risk. TEE can cause temporary (2 days), mild throat irritation. Despite
the surgeons expertise a small peroperative controllable bleedingrisk due to
LAA removal exists.
It is of the utmost importance to increase our understanding of this complex
pathophysiologic state considering its enormous socio-economical burden on
society. Since biopsy of the atrial wall is virtually impossible without
perforating the structure, subsequently creating a life-threatening situation,
surgical removal is the safest way to obtain atrial tissue.
P Debyelaan 25
6229 HX Maastricht
NL
P Debyelaan 25
6229 HX Maastricht
NL
Listed location countries
Age
Inclusion criteria
Inclusion criteria cases
1. Electrocardiographically established diagnosis of atrial fibrillation
2. Need for thoracic surgery (requiring median sternotomy);Inclusion criteria controls
1. 18 years or older
2. Need for thoracic surgery (requiring median sternotomy)
Exclusion criteria
Exclusion criteria cases
1. No written informed consent
2. Age under 18 years
3. Severe mitral or aortic valve disease
4. Secondary AF
5. Kidney dysfunction (GFR <30 ml/min, estimated by the Cockroft-Gault formula)
6. Use of experimental study medication in past 6 months;Exclusion criteria controls
1. Electrocardiographically established diagnosis of atrial fibrillation
2. Severe mitral or aortic valve disease
3. No written informed consent
4. Kidney dysfunction (GFR <30 ml/min, estimated by the Cockroft-Gault formula)
5. Use of experimental study medication in past 6 months
Design
Recruitment
Followed up by the following (possibly more current) registration
No registrations found.
Other (possibly less up-to-date) registrations in this register
No registrations found.
In other registers
| Register | ID |
|---|---|
| CCMO | NL19786.068.07 |