Angiotensin converting enzyme 2 activity and human atrial fibrillation: increased plasma angiotensin converting enzyme 2 activity is associated with atrial fibrillation and more advanced left atrial structural remodelling
- 12 October 2016
- journal article
- research article
- Published by Oxford University Press (OUP) in EP Europace
- Vol. 19 (8), 1280-1287
- https://doi.org/10.1093/europace/euw246
Abstract
Angiotensin converting enzyme 2 (ACE2) is an integral membrane protein whose main action is to degrade angiotensin II. Plasma ACE2 activity is increased in various cardiovascular diseases. We aimed to determine the relationship between plasma ACE2 activity and human atrial fibrillation (AF), and in particular its relationship to left atrial (LA) structural remodelling. One hundred and three participants from a tertiary arrhythmia centre, including 58 with paroxysmal AF (PAF), 20 with persistent AF (PersAF), and 25 controls, underwent clinical evaluation, echocardiographic analysis, and measurement of plasma ACE2 activity. A subgroup of 20 participants underwent invasive LA electroanatomic mapping. Plasma ACE2 activity levels were increased in AF [control 13.3 (9.5–22.3) pmol/min/mL; PAF 16.9 (9.7–27.3) pmol/min/mL; PersAF 22.8 (13.7–33.4) pmol/min/mL, P = 0.006]. Elevated plasma ACE2 was associated with older age, male gender, hypertension and vascular disease, elevated left ventricular (LV) mass, impaired LV diastolic function and advanced atrial disease (P < 0.05 for all). Independent predictors of elevated plasma ACE2 activity were AF (P = 0.04) and vascular disease (P < 0.01). There was a significant relationship between elevated ACE2 activity and low mean LA bipolar voltage (adjusted R2 = 0.22, P = 0.03), a high proportion of complex fractionated electrograms (R2 = 0.32, P = 0.009) and a long LA activation time (R2 = 0.20, P = 0.04). Plasma ACE2 activity is elevated in human AF. Both AF and vascular disease predict elevated plasma ACE2 activity, and elevated plasma ACE2 is significantly associated with more advanced LA structural remodelling.Keywords
Funding Information
- National Health and Medical Research Council
- National Heart Foundation of Australia
- National Health and Medical Research Council of Australia
This publication has 24 references indexed in Scilit:
- Recommendations for Cardiac Chamber Quantification by Echocardiography in Adults: An Update from the American Society of Echocardiography and the European Association of Cardiovascular ImagingEuropean Heart Journal – Cardiovascular Imaging, 2015
- Emerging markers in cardiovascular disease: Where does angiotensin‐converting enzyme 2 fit in?Clinical and Experimental Pharmacology and Physiology, 2013
- Circulating ACE2 activity is increased in patients with type 1 diabetes and vascular complicationsJournal of Hypertension, 2012
- Detection of Soluble Angiotensin-Converting Enzyme 2 in Heart Failure: Insights Into the Endogenous Counter-Regulatory Pathway of the Renin-Angiotensin-Aldosterone SystemJournal of the American College of Cardiology, 2008
- Angiotensin‐converting enzyme 2 catalytic activity in human plasma is masked by an endogenous inhibitorExperimental Physiology, 2008
- Electrophysiologic and electroanatomic changes in the human atrium associated with ageJournal of the American College of Cardiology, 2004
- Effects of angiotensin II type 1 receptor antagonist on electrical and structural remodeling in atrial fibrillationJournal of the American College of Cardiology, 2003
- Hydrolysis of Biological Peptides by Human Angiotensin-converting Enzyme-related CarboxypeptidaseJournal of Biological Chemistry, 2002
- Different Patterns of Angiotensin II and Atrial Natriuretic Peptide Secretion in a Sheep Model of Atrial FibrillationJournal of Cardiovascular Electrophysiology, 2001
- Atrial Fibrillation Activates Platelets and Coagulation in a Time-Dependent Manner: A Study in Patients With Paroxysmal Atrial FibrillationJournal of the American College of Cardiology, 1997