Abstract
Introduction
Understanding the interplay between metabolic syndrome and left atrial (LA) function is crucial, especially in patients newly diagnosed with atrial fibrillation (AF). We evaluated the association between subclinical atrial function and metabolic syndrome in patients diagnosed with new-onset AF.
Methods
A retrospective analysis was conducted on 220 patients, aged between 20 and 100 years, who were newly diagnosed with AF. These patients were divided into two groups based on the presence or absence of metabolic syndrome. LA reservoir strain, a measure of LA function, was assessed using transthoracic echocardiography. Statistical methods, including receiver operating characteristic (ROC) curve and logistic regression analyses, were employed to evaluate the association between LA strain and metabolic syndrome.
Results
Among the 220 patients, 108 had metabolic syndrome and displayed more adverse clinical characteristics. The LA reservoir strain was significantly lower in this group (9.7% ± 5.2% vs. 12.0% ± 5.8%, p = 0.003). ROC curve analysis identified 9.3% as the optimal cutoff value for predicting metabolic syndrome, with a sensitivity of 50.9% and specificity of 70.5%. Further, multivariate analysis confirmed that an LA reservoir strain below 9.3% was independently linked to metabolic syndrome (odds ratio 4.261, 95% confidence interval 1.134–16.009, p = 0.032).
Conclusions
The findings reveal a significant association between lower LA reservoir strain values and the presence of metabolic syndrome in patients newly diagnosed with AF. An LA strain value below 9.3% serves as a critical diagnostic and prognostic indicator, highlighting its clinical importance in managing patients with AF.
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Data Availability
The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.
References
Hindricks G, Potpara T, Dagres N, et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J. 2021;42:373–498.
Benjamin EJ, Muntner P, Alonso A, et al. Heart disease and stroke statistics-2019 update: a report from the American Heart Association. Circulation. 2019;139:e56–528.
Walters TE, Wick K, Tan G, et al. Symptom severity and quality of life in patients with atrial fibrillation: psychological function outweighs clinical predictors. Int J Cardiol. 2019;279:84–9.
Huh JH, Kang DR, Kim JY, Koh KK. Metabolic syndrome fact sheet 2021: executive report. Cardiometab Syndr J. 2021;1:125–34.
Oliver W, Matthews G, Ayers CR, et al. Factors associated with left atrial remodeling in the general population. Circ Cardiovasc Imaging. 2017;10:e005047.
Malaescu GG, Mirea O, Capota R, et al. Left atrial strain determinants during the cardiac phases. JACC Cardiovasc Imaging. 2022;15:381–91.
Sun BJ, Park JH, Lee M, et al. Normal reference values for left atrial strain and its determinants from a large Korean multicenter registry. J Cardiovasc Imaging. 2020;28:186–98.
Kim YG, Choi KJ, Han S, et al. Metabolic syndrome and the risk of new-onset atrial fibrillation in middle-aged East Asian men. Circ J. 2018;82:1763–9.
Kwon CH, Kim H, Kim SH, et al. The impact of metabolic syndrome on the incidence of atrial fibrillation: a nationwide longitudinal cohort study in South Korea. J Clin Med. 2019;8:1095.
Yilmaz H, Ozcan KS, Sayar N, et al. Metabolic syndrome is associated with atrial electrical and mechanical dysfunction. Med Princ Pract. 2015;24:147–52.
Grundy SM, Cleeman JI, Daniels SR, et al. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute scientific statement. Circulation. 2005;112:2735–52.
Hong AR, Lim S. Clinical characteristics of metabolic syndrome in Korea, and its comparison with other Asian countries. J Diabetes Investig. 2015;6:508–15.
Cameli M, Mandoli GE, Loiacono F, et al. Left atrial strain: a useful index in atrial fibrillation. Int J Cardiol. 2016;220:208–13.
Badano LP, Kolias TJ, Muraru D, et al. Standardization of left atrial, right ventricular, and right atrial deformation imaging using two-dimensional speckle tracking echocardiography: a consensus document of the EACVI/ASE/Industry Task Force to standardize deformation imaging. Eur Heart J Cardiovasc Imaging. 2018;19:591–600.
Pathan F, D’Elia N, Nolan MT, Marwick TH, Negishi K. Normal ranges of left atrial strain by speckle-tracking echocardiography: a systematic review and meta-analysis. J Am Soc Echocardiogr. 2017;30(59–70): e8.
Ionin V, Zaslavskaya E, Barashkova E, et al. Cardiotrophin-1 and components of metabolic syndrome: what is the role in the development of atrial fibrillation? EP Europace. 2021;23. https://doi.org/10.1093/europace/euab116.131.
Ionin VA, Zaslavskaya EL, Barashkova EI, et al. Molecular mechanisms of left atrial fibrosis development in patients with atrial fibrillation and metabolic syndrome: what biomarkers should be used in clinical practice? Russian J Cardiol. 2021;26:4579.
Biccire FG, Bucci T, Menichelli D, et al. Mediterranean diet: a tool to break the relationship of atrial fibrillation with the metabolic syndrome and non-alcoholic fatty liver disease. Nutrients. 2022;14:1260.
Zheng Y, Xie Z, Li J, et al. Meta-analysis of metabolic syndrome and its individual components with risk of atrial fibrillation in different populations. BMC Cardiovasc Disord. 2021;21:90.
Sabatino J, De Rosa S, Leo I, et al. Early reduction of left atrial function predicts adverse clinical outcomes in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement. Open Heart. 2021;8:e001685.
Tanasa A, Burlacu A, Popa C, et al. A systematic review on the correlations between left atrial strain and cardiovascular outcomes in chronic kidney disease patients. Diagnostics (Basel). 2021;11:671.
Nguyen J, Weber J, Hsu B, et al. Comparing left atrial indices by CMR in association with left ventricular diastolic dysfunction and adverse clinical outcomes. Sci Rep. 2021;11:21331.
Delgado V, Di Biase L, Leung M, et al. Structure and function of the left atrium and left atrial appendage: AF and stroke implications. J Am Coll Cardiol. 2017;70:3157–72.
Triposkiadis F, Xanthopoulos A, Butler J. Cardiovascular aging and heart failure: JACC review topic of the week. J Am Coll Cardiol. 2019;74:804–13.
Lin KJ, Cho SI, Tiwari N, et al. Impact of metabolic syndrome on the risk of atrial fibrillation recurrence after catheter ablation: systematic review and meta-analysis. J Interv Card Electrophysiol. 2014;39:211–23.
Balarini CM, Braga VA. Editorial: new translational insights on metabolic syndrome: obesity, hypertension. Diabetes and Beyond Front Physiol. 2016;7:229.
Park HS, Sung JH, Ryu CS, et al. The synergistic effect of plasminogen activator inhibitor-1 (PAI-1) polymorphisms and metabolic syndrome on coronary artery disease in the Korean population. J Pers Med. 2020;10:229.
Miller JT, O’Rourke RA, Crawford MH. Left atrial enlargement: an early sign of hypertensive heart disease. Am Heart J. 1988;116:1048–51.
Vidula MK, Chirinos JA. Left atrial coupling index and its prognostic value in heart failure with reduced ejection fraction. Circ Cardiovasc Imaging. 2021;14: e012221.
Chen YL, Chen YC, Chang YT, et al. GJA1 expression and left atrial remodeling in the incidence of atrial fibrillation in patients with obstructive sleep apnea syndrome. Biomedicines. 2021;9:1463.
Bao L, Cheng L, Gao X, et al. Left atrial morpho-functional remodeling in atrial fibrillation assessed by three dimensional speckle tracking echocardiography and its value in atrial fibrillation screening. Cardiovasc Ultrasound. 2022;20:13.
Acknowledgements
We thank the participants of the study.
Medical Writing, Editorial, and Other Assistance.
We would like to clarify that Heo Jeong-Heon, RT, provided technical assistance specifically in strain analysis for our study. His contributions were invaluable in ensuring the accuracy and reliability of the strain analysis data, which played a crucial role in our research findings. However, it is important to note that he did not participate in the writing or editing of the medical content of the paper, nor did he receive any funding for his contribution.
Authorship.
All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published.
Funding
This study was supported by the National Research Foundation of Korea (NRF) grant funded by the Korean Government (MSIT) (No. 2021R1G1A11003683). The journal’s Rapid Service fee was provided by the NRF grant.
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All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Hyun-Sun Kim, and Hyun-Jin Kim. The first draft of the manuscript was written by Hyun-Jin Kim and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
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Hyun-Jin Kim and Hyun-Sun Kim have nothing to disclose.
Ethical Approval
The study was approved by Hanyang University Guri Hospital’s institutional review board and conducted in accordance with the Declaration of Helsinki (No. GURI 2021–02–007). The requirement for written informed consent was waived by the institutional review boards.
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Kim, HJ., Kim, HS. Left Atrial Strain Insights in Atrial Fibrillation and the Interplay with Metabolic Syndrome. Adv Ther 41, 1685–1697 (2024). https://doi.org/10.1007/s12325-024-02815-y
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DOI: https://doi.org/10.1007/s12325-024-02815-y