{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T00:13:41Z","timestamp":1793146421196,"version":"4.5.0"},"reference-count":66,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"20","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2025,10,21]]},"abstract":"<jats:sec xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">Postoperative atrial fibrillation occurs in ~40% after cardiac surgery. Mineralocorticoid receptor antagonists (MRA) are known to reduce chronic atrial fibrillation (AF) development and burden. We evaluated the association of preoperative MRA use with postoperative atrial fibrillation and investigated atrial cell types modulated by MRAs during cold preservation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p xml:lang=\"en\">We studied 19\u2009042 cardiac surgery patients at Mayo Clinic. Propensity 1:3 matching identified 298 MRA users and 894 non\u2010users. A subgroup analysis of patients on any preoperative diuretic was performed to isolate cardiac\u2010specific effects of MRAs, matching 298 MRA users to 894 non\u2010MRA diuretic users. AF recurrence was assessed for up to 6\u2010years. Single\u2010nucleus RNA sequencing (snRNA\u2010seq) was performed on human donor atria exposed to canrenone (a water\u2010soluble MRA) during cold preservation with ex\u2010vivo reperfusion, and expression profiles were compared with atria from patients with AF.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      After matching, preoperative MRA use was associated with a lower incidence of postoperative atrial fibrillation (19.8% versus 31.8%,\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      &lt;0.001). In the diuretic\u2010only subgroup, MRA users also had lower postoperative atrial fibrillation (19.8% versus 33.2%,\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      &lt;0.001). MRA use was associated with a reduced incidence of paroxysmal and chronic AF at 6\u2010years. snRNA\u2010seq identified a cardiomyocyte subpopulation, CM2, with high mineralocorticoid receptor expression where canrenone suppressed cold preservation\u2010induced mineralocorticoid receptor target gene expression, which was conversely elevated in chronic AF. Canrenone also attenuated stress\u2010response in atrial macrophages and pericytes.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">Preoperative MRAs were associated with reduced postoperative and long\u2010term AF after cardiac surgery. Mechanistically, our ex\u2010vivo human atrial model revealed that MRAs suppress mineralocorticoid receptor \u2010driven atrial stress responses, particularly in conduction\u2010relevant cardiomyocytes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.125.043661","type":"journal-article","created":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T12:12:02Z","timestamp":1760011922000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":7,"title":["Mineralocorticoid Receptor Antagonism Reduces Atrial Arrhythmias Post\u2010Cardiac Surgery and Attenuates Atrial Stress Responses to Cardioplegic Arrest"],"prefix":"10.1161","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4042-417X","authenticated-orcid":false,"given":"Sina","family":"Danesh","sequence":"first","affiliation":[{"name":"Mayo Clinic","place":["Rochester, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6687-1528","authenticated-orcid":false,"given":"Fazal","family":"Khan","sequence":"additional","affiliation":[{"name":"Mayo Clinic","place":["Rochester, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-1036-3635","authenticated-orcid":false,"given":"Trevor","family":"Chopko","sequence":"additional","affiliation":[{"name":"Mayo Clinic","place":["Rochester, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-4607-5188","authenticated-orcid":false,"given":"Aurora","family":"Lee","sequence":"additional","affiliation":[{"name":"Mayo Clinic","place":["Rochester, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ran","family":"Huo","sequence":"additional","affiliation":[{"name":"Mayo Clinic","place":["Rochester, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuyang","family":"Lu","sequence":"additional","affiliation":[{"name":"Mayo Clinic","place":["Rochester, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-2967-0614","authenticated-orcid":false,"given":"Vincy","family":"Tam","sequence":"additional","affiliation":[{"name":"Mayo Clinic","place":["Rochester, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9268-8823","authenticated-orcid":false,"given":"Wenbin","family":"Gao","sequence":"additional","affiliation":[{"name":"Mayo Clinic","place":["Rochester, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-7316-1411","authenticated-orcid":false,"given":"Austin","family":"Todd","sequence":"additional","affiliation":[{"name":"Mayo Clinic","place":["Rochester, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3239-6460","authenticated-orcid":false,"given":"Joseph J.","family":"Maleszewski","sequence":"additional","affiliation":[{"name":"Mayo Clinic","place":["Rochester, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4430-9969","authenticated-orcid":false,"given":"Francis D.","family":"Pagani","sequence":"additional","affiliation":[{"name":"University of Michigan Frankel Cardiovascular Center","place":["Ann Arbor, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0994-027X","authenticated-orcid":false,"given":"Hartzell","family":"Schaff","sequence":"additional","affiliation":[{"name":"Mayo Clinic","place":["Rochester, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2357-7825","authenticated-orcid":false,"given":"Y. Eugene","family":"Chen","sequence":"additional","affiliation":[{"name":"University of Michigan Frankel Cardiovascular Center","place":["Ann Arbor, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5052-2948","authenticated-orcid":false,"given":"Paul A.","family":"Friedman","sequence":"additional","affiliation":[{"name":"Mayo Clinic","place":["Rochester, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2237-0155","authenticated-orcid":false,"given":"Hakan","family":"Oral","sequence":"additional","affiliation":[{"name":"University of Michigan Frankel Cardiovascular Center","place":["Ann Arbor, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Metra","sequence":"additional","affiliation":[{"name":"Institute of Cardiology of the Civil Hospital, University of Brescia","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7703-0345","authenticated-orcid":false,"given":"Bertram","family":"Pitt","sequence":"additional","affiliation":[{"name":"University of Michigan Frankel Cardiovascular Center","place":["Ann Arbor, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ienglam","family":"Lei","sequence":"additional","affiliation":[{"name":"Mayo Clinic","place":["Rochester, USA"]},{"name":"Mayo Clinic","place":["Rochester, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4211-8587","authenticated-orcid":false,"given":"Paul C.","family":"Tang","sequence":"additional","affiliation":[{"name":"Mayo Clinic","place":["Rochester, USA"]},{"name":"Mayo Clinic","place":["Rochester, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.117.007558"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2014.9143"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1996.03540040044031"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/eur208"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00392-014-0754-7"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1507750"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejcts.2009.12.033"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2015.06.015"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2013.12.010"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacep.2024.05.030"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-135-12-200112180-00010"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1590\/s0066-782x2009000700011"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.4103\/2231-0770.102280"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2014.06.036"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2016.12.029"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/euv366"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1009492"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurjhf\/hfr119"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2021.04.079"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2005.01.015"},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2013.08.022"},{"key":"e_1_3_2_23_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0132592"},{"key":"e_1_3_2_24_2","doi-asserted-by":"publisher","DOI":"10.1097\/FJC.0000000000000097"},{"key":"e_1_3_2_25_2","doi-asserted-by":"publisher","DOI":"10.1097\/HJH.0000000000000284"},{"key":"e_1_3_2_26_2","doi-asserted-by":"publisher","DOI":"10.1016\/s0002-9149(01)01905-1"},{"key":"e_1_3_2_27_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.mayocpiqo.2020.07.012"},{"key":"e_1_3_2_28_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCEP.109.860221"},{"key":"e_1_3_2_29_2","doi-asserted-by":"publisher","DOI":"10.1093\/cvr\/cvq357"},{"key":"e_1_3_2_30_2","doi-asserted-by":"publisher","DOI":"10.1038\/nrcardio.2015.191"},{"key":"e_1_3_2_31_2","doi-asserted-by":"publisher","DOI":"10.1136\/hrt.2003.023069"},{"key":"e_1_3_2_32_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/eht507"},{"key":"e_1_3_2_33_2","doi-asserted-by":"publisher","DOI":"10.1038\/s44161-025-00653-x"},{"key":"e_1_3_2_34_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.yjmcc.2013.04.019"},{"key":"e_1_3_2_35_2","doi-asserted-by":"publisher","DOI":"10.3390\/antiox14040414"},{"key":"e_1_3_2_36_2","doi-asserted-by":"publisher","DOI":"10.1126\/scitranslmed.ade3782"},{"key":"e_1_3_2_37_2","doi-asserted-by":"publisher","DOI":"10.1038\/ncomms14049"},{"key":"e_1_3_2_38_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cell.2021.04.048"},{"key":"e_1_3_2_39_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13059-019-1874-1"},{"key":"e_1_3_2_40_2","doi-asserted-by":"publisher","DOI":"10.1038\/nbt.4314"},{"key":"e_1_3_2_41_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41587-020-0605-1"},{"key":"e_1_3_2_42_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41586-020-2797-4"},{"key":"e_1_3_2_43_2","doi-asserted-by":"publisher","DOI":"10.1101\/cshperspect.a035428"},{"key":"e_1_3_2_44_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41569-022-00759-w"},{"key":"e_1_3_2_45_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehaf024"},{"key":"e_1_3_2_46_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCRESAHA.120.316710"},{"key":"e_1_3_2_47_2","doi-asserted-by":"publisher","DOI":"10.1172\/JCI41080"},{"key":"e_1_3_2_48_2","doi-asserted-by":"publisher","DOI":"10.1126\/science.abq3061"},{"key":"e_1_3_2_49_2","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.1816847116"},{"key":"e_1_3_2_50_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41420-023-01506-x"},{"key":"e_1_3_2_51_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00018-024-05125-2"},{"key":"e_1_3_2_52_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41467-023-43945-1"},{"key":"e_1_3_2_53_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCHEARTFAILURE.124.011629"},{"key":"e_1_3_2_54_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jchf.2025.02.021"},{"key":"e_1_3_2_55_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2021.10.072"},{"key":"e_1_3_2_56_2","doi-asserted-by":"publisher","DOI":"10.2174\/1574884711666160714162128"},{"key":"e_1_3_2_57_2","doi-asserted-by":"publisher","DOI":"10.1097\/HJH.0000000000001105"},{"key":"e_1_3_2_58_2","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0b013e31825b8be2"},{"key":"e_1_3_2_59_2","doi-asserted-by":"publisher","DOI":"10.1002\/ejhf.1802"},{"key":"e_1_3_2_60_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehi645"},{"key":"e_1_3_2_61_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCRESAHA.122.322213"},{"key":"e_1_3_2_62_2","doi-asserted-by":"publisher","DOI":"10.1530\/JOE-16-0659"},{"key":"e_1_3_2_63_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCRESAHA.114.303211"},{"key":"e_1_3_2_64_2","doi-asserted-by":"publisher","DOI":"10.1074\/jbc.M113.519256"},{"key":"e_1_3_2_65_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cjco.2024.10.008"},{"key":"e_1_3_2_66_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2009.01.031"},{"key":"e_1_3_2_67_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2101897"}],"container-title":["Journal of the American Heart Association"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/JAHA.125.043661","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,19]],"date-time":"2025-11-19T11:20:25Z","timestamp":1763551225000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/JAHA.125.043661"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,21]]},"references-count":66,"journal-issue":{"issue":"20","published-print":{"date-parts":[[2025,10,21]]}},"alternative-id":["10.1161\/JAHA.125.043661"],"URL":"https:\/\/doi.org\/10.1161\/jaha.125.043661","relation":{"has-preprint":[{"id-type":"doi","id":"10.1101\/2025.02.24.639999","asserted-by":"object"}]},"ISSN":["2047-9980"],"issn-type":[{"value":"2047-9980","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,21]]},"assertion":[{"value":"2025-05-13","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-09-05","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-10-09","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e043661"}}