Li Linzi, Romaguera Dora, Alonso-Gómez Angel M, Toledo Estefanía, Shah Amit J, Mora Marta Noris, Tojal-Sierra Lucas, Martinez-Gonzalez Miguel Angel, Mas-Llado Caterina, Razquin Cristina, Estruch Ramón, Fitó Montserrat, Alonso Alvaro
medRxiv. 2024 Sep 18:2024.09.17.24313430. doi: 10.1101/2024.09.17.24313430.
Exploring longitudinal associations of blood biomarkers with left atrial (LA) structure and function can enhance our understanding of atrial fibrillation (AF) etiopathogenesis.
We studied 532 participants of the PREDIMED-Plus trial, a multicenter randomized trial in overweight and obese adults with metabolic syndrome. At baseline, 3 and 5 years after randomization, participants underwent transthoracic echocardiography and provided blood for serum biomarker measurements [propeptide of procollagen type I (PICP), high-sensitivity (hs) troponin T (hsTnT), hs C-reactive protein (hsCRP), 3-nitrotyrosine (3-NT), and N-terminal propeptide of B-type natriuretic peptide (NT-proBNP)]. Outcomes of interest included LA peak systolic longitudinal strain (LA PSLS), LA volume index (LAVi), LA function index (LAFi), and LA stiffness index (LASi). We performed cross-sectional and longitudinal analyses to evaluate relationships between log-transformed biomarkers and echocardiographic measurements using multiple linear regression and mixed models.
The participants in this analysis had a mean age of 65.0 (SD 4.8) years, and 40% were females. At baseline, increased NT-proBNP and hsTnT were associated with larger LAVi and worse LA function as measured by the LAFi, LASi, and LA PSLS. Longitudinally, higher NT-proBNP, but not higher hsTnT, was associated with increased LAVi and worsening LA function. Over 5 years, 1 unit increase in log(NT-proBNP) was associated with steeper decline in LA PSLS (-0.19%, 95% CI -0.35%, -0.02%) and greater increase in LAVi (0.28 mL/m2, 95% CI 0.10, 0.45) each year. PICP, hsCRP, and 3-NT did not show consistently significant associations with LA outcomes at baseline and through 5 years.
In an overweight and obese population, higher NT-proBNP was associated with LA volume enlargement and worsening LA function over 5 years. The implications of these findings for the prevention and prediction of AF warrant further investigation.
探索血液生物标志物与左心房（LA）结构和功能的纵向关联，有助于加深我们对心房颤动（AF）病因发病机制的理解。
我们研究了PREDIMED-Plus试验的532名参与者，这是一项针对患有代谢综合征的超重和肥胖成年人的多中心随机试验。在基线、随机分组后3年和5年时，参与者接受经胸超声心动图检查，并提供血液用于血清生物标志物测量[I型前胶原肽（PICP）、高敏（hs）肌钙蛋白T（hsTnT）、hs C反应蛋白（hsCRP）、3-硝基酪氨酸（3-NT）和B型利钠肽前体N端肽（NT-proBNP）]。感兴趣的结局包括左心房峰值收缩纵向应变（LA PSLS）、左心房容积指数（LAVi）、左心房功能指数（LAFi）和左心房僵硬度指数（LASi）。我们进行了横断面和纵向分析，使用多元线性回归和混合模型评估对数转换后的生物标志物与超声心动图测量值之间的关系。
本分析中的参与者平均年龄为65.0（标准差4.8）岁，40%为女性。在基线时，NT-proBNP和hsTnT升高与更大的LAVi以及LAFi、LASi和LA PSLS所测量的更差的左心房功能相关。纵向来看，较高的NT-proBNP而非较高的hsTnT与LAVi增加和左心房功能恶化相关。在5年期间，log(NT-proBNP)每增加1个单位，与LA PSLS每年更陡峭的下降（-0.19%，95%置信区间-0.35%，-0.02%）和LAVi每年更大的增加（0.28 mL/m2，95%置信区间0.10，0.45）相关。PICP、hsCRP和3-NT在基线和5年期间均未显示与左心房结局存在一致的显著关联。
在超重和肥胖人群中，较高的NT-proBNP与5年内左心房容积增大和左心房功能恶化相关。这些发现对心房颤动预防和预测的意义值得进一步研究。
