Strengths and limitations
This study has several strengths. First, this is the first clinical
study to investigate the expression of BRD4 in patients with
non-valvular and non-ischemic cardiomyopathy AF, as well as to
investigate the relationship between BRD4 and AF recurrence after
ablation. Second, this is the first study to investigate the role of
BRD4 in atrial fibrosis and AF via the TGF-β/Smads signaling pathway.
Third, this study is the first to describe the relationship between BRD4
and LAAPD, LVEF, and LVAs.
This study also has several limitations. First, the number of study
cases was relatively small, and a large sample of data was needed for
observation and analysis. Second, more accurate indicators of left
atrial size, such as left atrial volume index, are needed for further
validation. Third, the level of BRD4 in peripheral venous blood does not
fully represent the level of BRD4 in left atrial tissue, and it is
necessary to collect left atrial blood samples and left atrial tissue of
patients with AF for further verification (e.g., through myocardial
biopsy technology). Fourth, the animal experimental methodology was
relatively simple, and the mechanism study was not sufficiently
in-depth. BRD4 gene knockout and transfection technology should be
employed in the future to enhance BRD4 expression and verify the results
of this study from multiple perspectives. Fifth, we did not use enough
indicators to reflect atrial fibrosis, and more indicators are needed
for further verification (such as ST2 and galectin 3). Sixth, further
studies are needed to verify whether BRD4 inhibition could attenuate the
degree of LAVs in patients with AF and reduce the postoperative
recurrence rate of AF.