Vascular Cell Adhesion Molecule 1 in atrial fibrillation

Objective: Assessing whether serum Vascular Cell Adhesion Molecule 1(VCAM-1) concentration in the left atrial appendage(LAA) and the expression of VCAM-1 in LAA tissues are associated with the risk of atrial fibrillation-related stroke.

Method: Blood samples were collected from atrial fibrillation(AF) patients scheduled for catheter ablation of AF, both from within the LAA and peripheral veins(PV). The serum concentration of VCAM-1 was quantitatively analyzed using ELISA. Additionally, LAA tissues were obtained from AF patients undergoing cardiac surgery, and immunohistochemical quantification was conducted to assess VCAM-1 expression in these tissues. Univariate analysis and multivariate logistic regression were performed to examine the association between VCAM-1 levels and the risk of atrial fibrillation-related stroke.

Results: A total of 146 patients scheduled for AF ablation and 34 patients scheduled for cardiac surgery were enrolled in this study. Among these two groups, there were 67 cases (45.9%) and 13 cases (38.2%) of AF patients who experienced strokes, respectively. Serum analysis revealed that in the AF group with strokes, the LAA serum VCAM-1 concentration was higher compared to the AF group without strokes (631.64 ± 143.48 pg/ml vs. 336.71 ± 201.66 pg/ml, P < 0.001). Similarly, the PV serum VCAM-1 concentration was higher in the AF group with strokes compared to the group without strokes (591.65 ± 128.23 pg/ml vs. 257.71 ± 157.92 pg/ml, P < 0.001). Additionally, both the AF group with strokes and the group without strokes exhibited higher LAA serum VCAM-1 concentrations compared to PV serum concentrations (631.64 ± 143.48 pg/ml vs. 591.65 ± 128.23 pg/ml, P = 0.041) and (336.71 ± 201.66 pg/ml vs. 257.71 ± 157.92 pg/ml, P = 0.004).Regarding left atrial tissue analysis, the AF group with strokes had a higher average optical density value (AOD) of VCAM-1 compared to the group without strokes (1.257 ± 0.147 vs. 1.093 ± 0.161, P < 0.001), indicating a higher expression level of VCAM-1 in the LAA in the AF group with strokes. In univariate analysis, LAA serum VCAM-1 concentration (OR = 1.15, P < 0.001), PV VCAM-1 concentration (OR = 1.11, P < 0.001), and LAA VCAM-1 AOD value (OR = 3.04, P = 0.021) were all associated with the risk of atrial fibrillation-related stroke. In the multivariate logistic regression analysis, LAA serum VCAM-1 concentration (OR = 1.17, P = 0.002) and PV VCAM-1 concentration (OR = 1.30, P = 0.034) were predictive of atrial fibrillation-related stroke. Specifically, left atrial appendage serum VCAM-1 concentration greater than 387.93 pg/ml and peripheral vein VCAM-1 concentration greater than 344.04 pg/ml were predictive of atrial fibrillation-related strokes.

Conclusions: The risk of stroke in AF is associated with VCAM-1, and elevated serum VCAM-1 concentrations in AF patients who experience strokes may be attributed not only to systemic inflammatory responses but also to increased VCAM-1 expression in LAA tissues. Serum VCAM-1 concentrations in AF patients can serve as predictive factors for atrial fibrillation-related stroke, with LAA serum VCAM-1 concentrations exceeding 387.93 pg/ml and peripheral vein VCAM-1 concentrations exceeding 344.04 pg/ml being predictive of atrial fibrillation-related strokes.