The significance of high sensitive troponin i and left atrial mechanical dispersion in middle-aged patients with atrial fibrillation

Abstract Funding Acknowledgements Type of funding sources: None. Background Atrial fibrillation (AF) is a progressive disease and can initiates and maintains in the absence of left atrial (LA) enlargement¹´². Echocardiographic parameters of LA mechanics had been proposed for best dealing with patients in AF³ . Combining different laboratory biomarkers with echocardiographic parameters can improve prediction, detection and treatment of AF in clinical practice. However, there is limited data about the significance of combination of novel echocardiographic and laboratory biomarkers in prediction of AF in middle-aged patients without LA enlargement. Purpose To investigate middle- aged AF patients with normal standart 2D echocardiography (2DE) to establish novel echocardiographic and laboratory biomarkers as predictors of reccurent AF. Methods Prospective consecutive patients with symptomatic AF (n= 936), were screened for participation in the study. A total of 70 patients met the inclusion criteria- stable sinus rhythm for more than 3 weeks, age between 40–60 years, without over heart disease and normal 2DE. They were separated in two groups: with new-onset AF (n=33) and recurrent episode of AF (n=37); 30 healthy subjects were enrolled in the control group. All patients underwent 2DE with speckle- tracking analyses and biomarker assays were collected, including baseline high sensitive troponin I (hsTnI), galectin-3, uric acid and hsCRP. Results There were significant differences between all groups in echocardiographic parameters of LA mechanics: LA reservoir, conduit and contractile strain and strain rate respectively, LA stiffness index- table 1. There were significant differences in laboratory markers- hsTnI and uric acid between groups. Moreover, pro-fibrotic biomarker Galectin-3 was higher only in patients with reccurent AF as was LA mechanical dispersion from speckle-tracking analysis. There were no differences in hsCRP between groups. Binary regression analysis demonstrated that hsTnI (OR 1,880; p< 0,025; 1,084- 3,260 95,0% CI) and LA mechanical dispersion (OR 1,012; p< 0,034; 1,001- 1,024 95,0% CI) are predictors of reccurent AF- ROC curve image . Conclusion As a progressive disease AF facilitates its own persistence through LA structural and functional remodeling. Left atrial dispersion along with baseline hsTnI may have additive value for prediction of reccurent AF episodes, reflecting this process in middle-aged patients without LA enlargement.