Usefulness of Triglyceride-glucose index for detecting prevalent atrial fibrillation in a type 2 diabetic population

Atrial fibrillation (AF) is the most common arrhythmias, which significantly jeopardizes global cardiovascular health through the complicated heart failure and stroke. Published studies have demonstrated the impact of insulin resistance on the genesis of AF. Hence, monitoring insulin resistance may be a possible way to improve the detection of early-stage AF. Accordingly, our work aimed to investigate the association between TyG, a surrogate of insulin resistance, and the prevalent AF, and to evaluate the potential of TyG to refine the detection of prevalent AF in a diabetic population. This cross-sectional study was derived from the National Metabolic Management Center Program and included 3244 diabetic patients between September 2017 and December 2020. TyG was calculated as ln[fasting TG (mg/ dL)× FPG (mg/dL)/2]. AF was diagnosed according to electrocardiography and subjects’ self-reports. The prevalence of AF was 6.57%. In the fully adjusted model, each SD elevation of TyG cast a 40.6% additional risk for prevalent AF. In the quartile analysis, the top quartile showed a 2.120 times risk of prevalent AF compared with the bottom quartile. Smooth curve fitting demonstrated that the association was linear in the full range of TyG, and subgroup analysis suggested that the association was robust in several common subpopulations of AF. Furthermore, ROC results displayed an improvement for the detection of prevalent AF when adding TyG into conventional cardiovascular risk factors (0.812vs.0.825, P = 0.019), and continuous net reclassification index (0.227, 95% CI: 0.088–0.365, P = 0.001) and integrated discrimination index (0.007, 95% CI: 0.001–0.012, P = 0.026) also showed the improvement achieved by TyG. Our data supported a linear and robust correlation between TyG and the prevalent AF in a diabetic population. Moreover, our results implicated the potential usefulness of TyG to refine the detection of prevalent AF in a diabetic population.</p

Data_Sheet_1_Association between weight-adjusted-waist index and heart failure: Results from National Health and Nutrition Examination Survey 1999–2018.docx

BackgroundWeight-adjusted waist circumference index (WWI) is a novel index positively associated with excessive fat accumulation. The current study aims to evaluate the association between WWI and the prevalent heart failure (HF), and to assess the value of WWI to improve the detection of HF in the general population.MethodsA total of 25,509 subjects from National Health and Nutrition Examination Survey 1999–2018 were included into our study. WWI was calculated as WC (cm) divided by the square root of weight (kg). HF was identified according to the subjects’ reports.ResultsThe prevalence of reported HF was 2.96%. With adjustment of demographic, anthropometric, laboratory, and medical history data, one SD increment of WWI could cast an additional 19.5% risk for prevalent HF. After separating WWI into quartiles, the fourth quartile had a 1.670 times risk of prevalent HF compared to the first quartile. Furthermore, smooth curve fitting suggested that the association was linear in the entire range of WWI. Moreover, the association was robust to subgroups of age, sex, race, obesity, hypertension, and diabetes. Additionally, ROC analysis revealed a significant improvement for the detection of prevalent HF from WWI (0.890 vs. 0.894, P ConclusionOur data demonstrated a significant, linear, and robust association between WWI, a simple surrogate for fat mass accumulation, and the risk for prevalent HF in a representative population. Moreover, our results also suggested the potential value of WWI to refine the detection of prevalent HF in the general population.</p

Primer sets for PCR amplification.

<p>Primer sets for PCR amplification.</p

Role of the MAPKs/TGF-β1/TRAF6 signaling pathway in postoperative atrial fibrillation

<div><p>Objectives</p><p>To explore the relationship between the MAPKs/TGF-β1/TRAF6 signaling pathway and atrial fibrosis in patients with rheumatic heart disease (RHD) and its role in atrial fibrillation (AF) after cardiac surgery on the basis of our previous animal study of the MAPKs/TGF-β1/TRAF6 signaling pathway in atrial fibrosis.</p><p>Methods</p><p>A total of 57 patients with RHD without a history of AF consented to left atrial biopsy. Histopathology quantified the percentage of fibrosis, and real-time PCR and western blot assessed the mRNA and protein expression of TGF-β1, TRAF6, and connective tissue growth factor (CTGF), respectively. Western blot was also used to measure the protein expression of phosphorylated MAPKs and TGF-β-activated kinase 1 (TAK1). Serum angiotensin II (Ang II) levels were assayed using enzyme-linked immunosorbent assay (ELISA).</p><p>Results</p><p>Eighteen patients developed AF, whereas 39 remained in sinus rhythm (SR). The severity of atrial fibrosis was significantly higher in patients who developed AF versus those who remained in SR; the mRNA and protein expression of TGF-β1, TRAF6 and CTGF were significantly higher in patients with AF. The protein expression of phosphorylated MAPKs and TAK1 was significantly increased in patients who developed AF compared with the patients who remained in SR. Serum Ang II levels were significantly higher in patients who developed AF versus those who remained in SR.</p><p>Conclusion</p><p>The MAPKs/TGF-β1/TRAF6 signaling pathway is involved in atrial fibrosis in patients with RHD, which results in the occurrence of AF after cardiac surgery.</p></div

H&E and Masson's trichrome staining of the atrial appendage in SR(A, C) and postoperative AF (B, D) patients (magnification 400×).

<p>Compared with SR patients, atrial muscle distribution showed disarray and myocytolysis in postoperative AF patients. There was a significant difference in the fibrosis score between the two groups (E). The bars indicate the means ± SEM.</p> <p>SR = remained in normal sinus rhythm, AF = developed new onset postoperative atrial fibrillation, **p<0.01. All 57 patients are fibrosis scored and represented in panel E.</p

The mRNA expression of TGFβ1 (A), TRAF6 (B) and CTGF (C) in the postoperative AF group was markedly higher than that in the SR group.

<p>In each group, tissue samples from 15 random patients were used. All experiments were performed 3 times. Serum Ang II levels were measured in all patients and were significantly higher in patients who developed AF versus those who remained in SR (D). Bars correspond to the mean ± SEM.</p> <p>SR = remained in normal sinus rhythm, AF = developed new onset postoperative atrial fibrillation, **p<0.01, *p<0.05.</p

A: Representative western blot of TGFβ1, TRAF6, CTGF and TAK1.

<p>Each band represents one patient with either postoperative AF or SR. The protein expression of TGFβ1 (B), TRAF6 (C), CTGF (D) and phosphorylated TAK1 (E) increased significantly in the postoperative AF group. Bars correspond to the mean ± SEM. In each group, tissue samples from 15 random patients were used. All experiments were performed 3 times.</p> <p>SR = remained in normal sinus rhythm, AF = developed new onset postoperative atrial fibrillation, *p<0.05.</p

AngII-induced MAPK/TGF-β1/TRAF6/TAK1 signaling pathway in postoperative atrial fibrillation.

<p>Binding of Ang II to AT1 receptor induces activation of MAPK, which increases the expression of TGF-β1. Then, paracrine production of TGF-β1 activates the signaling pathway of TRAF6/TAK1. Activation of the above signaling pathway promotes the proliferation of atrial fibroblasts, leading to atrial fibrosis.</p

Patient variables.

<p>ACEI = angiotensin-converting enzyme inhibitor; AT antagonist = angiotensin receptor I antagonist; IVSd = interventricular septum; LA = left atrium; LVEDd = left ventricular end-diastolic diameter; LVEF = left ventricular ejection fraction; LVESd = left ventricular end-systolic diameter; LVPWd = Left Ventricular Posterior Wall Depth; PAP = Pulmonary artery pressure.</p

A: Representative western blot of MAPKs. Each band represents one patient with either postoperative AF or SR.

<p>The protein expression of phosphorylated P38 MAPKs (B), ERK1/2 (C) and JNK (D) in the postoperative AF group was significantly higher than that in the SR group. Bars correspond to the mean ± SEM. In each group, tissue samples from 15 random patients were used. All experiments were performed 3 times.</p> <p>SR = remained in normal sinus rhythm, AF = developed new onset postoperative atrial fibrillation, *p<0.05.</p