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Serum osteoprotegerin level is independently related to subclinical left atrial mechanical function in patients with hypertension and diabetes

Unabhängiger Zusammenhang zwischen Serumosteoprotegerinspiegel und subklinisch abnormer linksatrialer mechanischer Funktion bei Patienten mit Hypertonie und Diabetes

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Abstract

Objectives

Previous studies showed that subclinical abnormal left atrial (LA) function could be diagnosed with LA speckle tracking evaluation long before chamber enlargement. Osteoprotegerin (OPG) is a member of the tumor necrosis factor (TNF) receptor superfamily and was recently found to be an indicator for adverse cardiovascular outcomes and a risk factor for new onset atrial fibrillation. The authors hypothesized that OPG values could predict LA mechanical dysfunction and LA remodeling assessed by two-dimensional speckle tracking echocardiography (2D-STE) in patients with hypertension (HT) and diabetes mellitus (DM).

Methods

A single center study was conducted including consecutive patients presenting to the authors’ outpatient clinic. Enrolled patients needed to have been treated for HT and DM for at least 1 year.

Results

The study included 80 patients (mean age, 57.5 ± 8.3 years). Patients in the impaired LA strain group were older (p = 0.035), had lower low density lipoprotein (LDL) cholesterol (mg/dl) (p = 0.021), and higher OPG (pmol/l) (p = 0.004) values than patients in the normal LA strain group. Univariate logistic regression analysis demonstrated that age (p = 0.039), LDL cholesterol (mg/dl) (p = 0.025), and OPG (pmol/l) (p = 0.008) values were associated with impaired LA strain. Backward multivariate logistic regression analysis showed that LDL cholesterol (mg/dl) (OR: 0.982, CI 95% 0.964–0.999, p = 0.049) and OPG (pmol/l) (OR: 1.438, CI 95% 1.043–1.983, p = 0.027) were independently associated with impaired LA strain.

Conclusion

In hypertensive and diabetic patients, higher OPG values were associated with impaired LA function assessed by 2D-STE. In this high-risk patient group, serum OPG can be used as a risk predictor for LA mechanical dysfunction.

Zusammenfassung

Zielsetzung

Frühere Studien belegen, dass eine subklinisch gestörte linksatriale (LA) Funktion mithilfe der linksatrialen Speckle-tracking-Analyse lange vor einer Kammervergrößerung diagnostiziert werden kann. Osteoprotegerin (OPG) gehört zur Familie der Tumor-Nekrose-Faktor(TNF)-Rezeptor-Superfamilie und wurde vor Kurzem als Indikator eines ungünstigen kardiovaskulären Verlaufs und als Risikofaktor für neu auftretendes Vorhofflimmern identifiziert. Es wird postuliert, dass die OPG-Werte bei Patienten mit Hypertonie (HT) und Diabetes mellitus (DM) ein Prädiktor für mechanische LA-Dysfunktion und LA-Remodeling in der zweidimensionalen Speckle-tracking-Echokardiographie (2D-STE) sind.

Methoden

In eine Single-Center-Studie wurden konsekutiv Patienten eingeschlossen, die sich in der Klinik der Autoren ambulant vorstellten. Voraussetzung für den Einschluss war eine mindestens 1‑jährige Behandlung wegen HT und DM.

Ergebnisse

Insgesamt 80 Patienten wurden in die Studie eingeschlossen (Durchschnittsalter 57,5 ± 8,3 Jahre). Die Patienten in der Gruppe mit gestörtem LA-Strain waren älter (p = 0,035), hatten einen niedrigeren Low-density-Lipoprotein(LDL)-Cholesterin-Spiegel (mg/dl; p = 0,021) und höhere OPG-Spiegel (pmol/l; p = 0,004) als Patienten in der Gruppe mit normalem LA-Strain. Eine univariate logistische Regressionsanalyse ergab, dass das Alter (p = 0,039), LDL-Cholesterin (mg/dl; p = 0,025) und OPG (pmol/l; p = 0,008) mit einem gestörten LA-Strain assoziiert waren. In einer rückwärts gerichteten multivariaten logistischen Regressionsanalyse waren LDL-Cholesterin (mg/dl; OR 0,982, 95%-Konfidenzintervall [KI] 0,964–0,999, p = 0,049) und OPG (pmol/l; OR 1,438, 95%-KI 1,043–1,983, p = 0,027) unabhängig mit einem gestörten LA-Strain assoziiert.

Schlussfolgerung

Bei Patienten mit Hypertonie und Diabetes waren höhere OPG-Werte mit einer gestörten LA-Funktion in der 2D-STE assoziiert. In dieser Hochrisikogruppe kann der Serum-OPG-Spiegel als Risikoprädiktor der mechanischen LA-Dysfunktion genutzt werden.

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Authors and Affiliations

  1. Department of Cardiology, University of Health Sciences Turkey, Ahi Evren Chest and Cardiovascular Surgery Education and Research Hospital, Trabzon, Turkey

    Ezgi Kalaycıoğlu MD & İsmet Durmuş MD

  2. Department of Cardiology, Recep Tayyip Erdogan University Faculty of Medicine, Training and Research Hospital, Rize, Turkey

    Mustafa Çetin MD & Ali Gökhan Özyıldız MD

  3. Department of Cardiology, Kackar State Hospital, Rize, Turkey

    Göksel Çinier MD

  4. Department of Cardiology, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey

    Tuncay Kırış MD

  5. Department of Cardiology, Hitit University Faculty of Medicine, Erol Olcok Education and Research Hospital, Corum, Turkey

    Tayyar Gökdeniz MD

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  1. Ezgi Kalaycıoğlu MD
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  2. Mustafa Çetin MD
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  3. Göksel Çinier MD
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  4. Tuncay Kırış MD
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  5. Tayyar Gökdeniz MD
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  6. Ali Gökhan Özyıldız MD
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  7. İsmet Durmuş MD
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Correspondence to Ezgi Kalaycıoğlu MD.

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Conflict of interest

E. Kalaycıoğlu, M. Çetin, G. Çinier, T. Kırış, T. Gökdeniz, A.G. Özyıldız, and İ. Durmuş declare that they have no competing interests.

All procedures performed in studies involving human participants or on human tissue were in accordance with the ethical standards of the institutional and/or national research committee and with the 1975 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

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Kalaycıoğlu, E., Çetin, M., Çinier, G. et al. Serum osteoprotegerin level is independently related to subclinical left atrial mechanical function in patients with hypertension and diabetes. Herz 46, 277–284 (2021). https://doi.org/10.1007/s00059-020-04939-7

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  • DOI: https://doi.org/10.1007/s00059-020-04939-7

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