Early-stage atrial cardiomyopathy in middle-aged obese adults with atrial fibrillation: diagnostic value of advanced echocardiography and biomarkers
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Atrial fibrillation (AF) and atrial cardiomyopathy (AtCM) share overlapping pathophysiological mechanisms, with atrial structural and functional abnormalities playing a pivotal role in disease development. Aim : This study aimed to evaluate advanced echocardiographic parameters alongside circulating biomarkers in middle-aged obese patients without overt heart disease, to identify early indicators of atrial dysfunction and AtCM. Methods : We prospectively studied 100 obese patients aged 40–60 years with new-onset or paroxysmal AF. A comprehensive echocardiographic assessment including volumetric analysis, speckle-tracking strain imaging, and tissue Doppler imaging was performed to evaluate left (LA) and right atrial (RA) function. Circulating biomarkers of fibrosis (Galectin-3) and myocardial injury (high-sensitivity troponin I, hsTnI) were measured. Thirty age-matched healthy controls without cardiovascular disease served as the comparison group. Results : Significant structural and functional abnormalities were observed in both atria of obese AF patients, with more pronounced changes in the LA. LA reservoir and contractile strain, as well as electromechanical delay (EMD), were markedly impaired. Paroxysmal AF patients demonstrated elevated Galectin-3 and hsTnI levels compared to those with new-onset AF and controls, indicating more advanced fibrotic remodelling and myocardial stress. LA stiffness index and strain parameters showed strong correlations with Galectin-3 concentrations. Conclusion : In middle-aged obese individuals without overt heart disease, advanced echocardiographic indices ( particularly atrial strain and EMD), combined with biomarkers such as Galectin-3 and hsTnI can provide sensitive early markers of atrial dysfunction and AtCM. Integrating these tools may improve early diagnosis, risk stratification, and guide timely interventions aimed at preventing AF progression.
