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Title: 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
Austin Authors: Walters, Tomos E;Kalman, Jonathan M;Patel, Sheila K ;Mearns, Megan;Velkoska, Elena;Burrell, Louise M 
Affiliation: Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
Department of Medicine, The University of Melbourne, Royal Melbourne Hospital, Parkville, Victoria, Australia
Department of Medicine, The University of Melbourne, Austin Health, Heidelberg, Victoria, Australia
Department of Cardiology, Austin Health, Heidelberg, Victoria, Australia
Issue Date: 1-Aug-2017 2016-10-12
Publication information: Europace 2017; 19(8): 1280-1287
Abstract: AIM: 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. METHODS AND RESULTS: 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). CONCLUSION: 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.
DOI: 10.1093/europace/euw246
ORCID: 0000-0003-1863-7539
PubMed URL:
Type: Journal Article
Subjects: Atrial fibrillation
ACE2 activity
Atrial remodelling
Appears in Collections:Journal articles

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