Additional diagnostic criteria for atrial cardiomyopathy in patients with lone atrial fibrillation

Aim. To determine additional diagnostic criteria for class I atrial cardiomyopathy (ACM) in patients with lone atrial fibrillation (AF).

Material and methods. This cross sectional non-randomized clinical study included 170 stable patients <60 years of age, of which 99 patients were selected. The inclusion criteria in the first group were the presence of lone AF with increased left atrial (LAVI) or right atrial volume index according to echocardiography without cardiovascular and pulmonary diseases, hypertension, and diagnostic criteria for heart failure (HF). The inclusion criterion in the second group was combination of AF and HF. The inclusion criterion in the third group was diagnostic criteria for HF (N-terminal pro-brain natriuretic peptide >125 ng/ml) in patients with sinus rhythm. In all patients, the concentration of NT-proBNP, a soluble stimulating growth factor 2 (sST2), as well as creatinine and cystatin C with calculation of the glomerular filtration rate, tissue inhibitor of matrix metalloproteinases-1 (TIMP1), and neutrophil gelatinase associated lipocalin (NGAL) was determined. Non-invasive angiography was performed.

Results. According to ROC analysis, NT-proBNP, TIMP-1, NGAL as markers of class I ACM in patients with lone AF, showed unsatisfactory clinical significance. In patients with ACM and AF, regardless of the presence/ absence of HF, direct moderate relationship between sST2 and LAVI (r=0,470, p=0,012) and direct strong correlation between sST2 and NT-proBNP (r=0,726, p=0,004). Using ROC curve, for all available sST2 values, its diagnostic significance was obtained in the range from 5 to 16 ng/ml (AUC=0,98).

Conclusion. The blood concentration of sST2 in the range from 5 to 16 ng/ml can be considered as an additional diagnostic criterion for class I ACM in patients with lone AF with a sensitivity of 98% and a specificity of 80%.

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