TET2 mutation is associated with interatrial block and postoperative atrial fibrillation after cardiac surgery: A fibrosis-related effect? - 21/05/25
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Résumé |
Introduction |
Hematopoietic somatic mosaicism (HSM) is a recently identified risk factor for cardiovascular diseases and atrial fibrillation (AF). TET2 mutation is one of the most common mutation in HSM. Its role in postoperative atrial fibrillation (POAF) after cardiac surgery remains unclear.
Objective |
The aim of the study is to assess the impact of TET2 mutation on preoperative atrial remodeling and POAF incidence after cardiac surgery.
Method |
Blood DNA from 656 patients referred for cardiac surgery was genotyped on a large genes panel to assess HSM, including TET2 mutation. Atrial remodeling was assessed based on multiparametric approach including interatrial block (IAB) assessment (P wave duration >120ms on ECG), left atrium (LA) echocardiography evaluation and right atrial fibrosis assessment using Red Sirius staining on fresh atrial tissue collected during surgery.
Results |
656 patients were included. 282 patients (43%) carried HSM (HSM+). DNMT3A (18.4%) and TET2 mutation (12.5%) were more prevalent. HSM+ patients were older (70y [64;76] vs 66y [58;72], P<0.001) and present more often AF prior to surgery (16% vs 9%, P=0.003). HSM+ status was associated with a higher incidence of POAF (50% vs 38%, P<0.01) with a higher incidence observed in patients carrying TET2 mutation (age-adjusted OR 2.20; 95% CI 1.31–3.72, P<0.01) (Figure 1A). Preoperative IAB trended to be more frequent in HSM+ patients (27% vs 21%, P=0.06) and was significantly more prevalent in patients carrying TET2 mutation (prevalence 37%, age-adjusted OR 1.82; 95% CI 1.02–3.29, P=0.04) (Figure 1B). No significant difference was observed regarding LA-related echocardiographic parameters. In a subgroup of 20 patients with available atrial tissue, patients with TET2 mutation presented a trend toward increased atrial fibrosis compared to HSM- (Red Sirius staining 8.9% [6.5–12.1] vs 4.9% [2.1–10.7], P=0.06) (Figure 1C).
Conclusion |
TET2 mutation is associated with a higher risk of POAF, with prolongation of atrial conduction on ECG and trend toward increased atrial fibrosis. These data suggest that TET2 mutation could be associated with a higher degree of atrial fibrosis leading to POAF after cardiac surgery.
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Vol 118 - N° 6-7S1
P. S216 - juin 2025 Retour au numéro
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