Relationship Between Bile Acid Levels And Atrial Fibrillation In Patients With Dilated Cardiomyopathy

Objective:To explore the relationship between total bile acid(TBA)level and atrial fibrillation(AF)in patients with dilated cardiomyopathy(DCM)and its clinical significance.Methods:TBA was measured in 210 DCM patients and clinical data were collected,including general clinical data,serum biochemical data,NT-proBNP,echocardiography,12-lead electrocardiogram and 24-hour dynamic electrocardiogram.The interventricular septum thickness,left atrial anteroposterior diameter,left ventricular posterior wall thickness and left ventricular end-diastolic diameter were measured by echocardiography.The left ventricular ejection fraction was measured by the Siompson method.(1)DCM patients were divided into DCM with atrial fibrillation group and DCM with sinus rhythm group according to the occurrence of atrial fibrillation.The general clinical data,laboratory data and echocardiographic data were compared between the two groups.Logistic regression was performed with or without atrial fibrillation as a dependent variable;(2)DCM patients were divided into NYHA class II,III and IV according to NYHA cardiac function classification,and the differences of serum NT-proBNP,TBA and LVEF were compared among the groups;(3)DCM patients were divided into elevated serum TBA group and normal serum TBA group according to TBA level,and the incidence of atrial fibrillation was compared between the two groups.The serum TBA was further divided into four groups according to the quartile method,and the incidence of atrial fibrillation among the four groups was compared.Results:1.A total of 210 patients with DCM were included.Gender,alcohol history,family history,smoking history,history of hypertension,history of diabetes,mean heart rate,diastolic blood pressure,systolic blood pressure,body mass index,total triglycerides,total cholesterol,alanine aminotransferase,aspartate aminotransferase,homocysteine,low density lipoprotein cholesterol,high density lipoprotein cholesterol,serum creatinine,urea nitrogen,uric acid,fasting blood glucose,alkaline phosphatase.There were no significant differences in the comparison of the total bilirubin,NT-proBNP,left ventricular end-diastolic diameter,ventricular septal thickness,left ventricular posterior wall thickness,left ventricular mass fraction and pulmonary hypertension(P > 0.05).With logistic regression analysis,age of patients(OR: 1.044,95% CI: 1.005~1.085,P = 0.028),left atrial diastolic diameter(OR:1.273,95% CI: 1.173~1.382,P < 0.001),TBA(OR: 1.088,95% CI:1.018~1.163,P = 0.013)were independent influencing factors of AF in patients with DCM,DCM patients increase their risk of AF by 4.4% for each additional year of age,With an increase of 1 mm in the left atrial diastolic,the risk of AF increased by 27.3%,increased risk of AF by 8.8% with TBA increase of 1 ?mol/L.2.Patients with DCM were divided into NYHA class II(23/210,10.95%),NYHA class III(145/210,69.05%),NYHA class IV(42/210,20.00%)according to NYHA cardiac function classification.TBA,NT-proBNP and LVEF were compared between the three groups.TBA and NT-proBNP were observed increasing with the increase of NYHA,while LVEF showed a downward trend,and both the differences were statistically significant(P < 0.05).3.According to TBA level,the patients were divided into DCM with elevated TBA level group(TBA> 10.0 ?mol/L,n = 50)and DCM with normal TBAlevel group(0.1 ?mol/L<TBA<10.0 ?mol/L,n = 160),of which 36 cases(72%)were AF in the elevated TBA level group and 36 cases(22.5%)were AF in the normal TBA level group.The incidence of AF in the two groups was significantly different(P < 0.05).Further classification of TBA levels by quartile method showed that there was no significant difference in the incidence of AF between the first group and the second group(P> 0.05),but there was significant difference in the incidence ofAF between the other groups(P < 0.05).ConclusionPatients with dilated cardiomyopathy have a significant increase in total bile acid levels associated with atrial fibrillation.After adjusting for other influencing factors,the increase in total bile acid levels can be used as an independent influencing factor for atrial fibrillation in patients with dilated cardiomyopathy.