Role of serum uric acid and transforming growth factor β2 in atrial structural remodelling in patients with heart failure combined with atrial fibrillation with preserved ejection fraction based on CHARGE-AF model analysis

REN Ling; WANG Qi-guang; LI Ben-shen; LI Lin-ke; LI Xin-yue; YU Chang-lian; HU Chang-qing

doi:10.3969/j.issn.1672-5301.2025.05.007

Abstract：Objective To investigate the role of serum uric acid(UA)and transforming growth factor β2(TGF-β2)in the structural remodelling of atrial fibrillation(AF)in patients with heart failure with preserved ejection fraction(HFpEF)combined with AF based on the CHARGE-AF model.Methods The study included 233 patients with HFpEF combined with AF in the General Hospital of the Northern Theatre between January 2018 and January 2020,who were classified into low,intermediate,and high-risk groups based on cardiac ultrasound,clinical symptoms,and signs,112,53,and 68 patients each.General data,serum UA,TGF-β2 and other laboratory indicators were collected,and cardiac structural remodeling was evaluated by echocardiography and magnetic resonance imaging(MRI).Multivariate Logistic regression analysis was used to calculate OR and 95％CI.Based on the original CHARGE-AF model and its enhanced model,the risk of AF structural remodeling was evaluated,and C statistics,R2D and 5-year cumulative incidence were calculated.The calibration of the model was evaluated by the Greenwood-Nam-D'Agostino test,and the optimistic estimates and adjusted C statistics were calculated to ensure the prediction accuracy.Results The serum UA,TGF-β2,Galectin-3,N-terminal pro-B-type natriuretic peptide(NT-proBNP),left atrial volume index(LAVI),right ventricular basal diameter(RVD),P wave duration and atrial premature beat related indexes in the high risk group were significantly higher than those in the middle and low risk groups,and the degree of fibrosis was also significantly increased in the high risk group.Tricuspid annular plane systolic excursion(TAPSE)was significantly lower than the other two groups(P＜0.05).For every 1 μmol/L increase in serum UA level,the risk of AF structural remodeling increased by 1.20％(OR=1.012,P＜0.05);for every 1 pg/ml increase in TGF-β2 level,the risk increased by 0.80％(OR=1.008,P＜0.05).The C statistic of the original CHARGE-AF model was 0.768,and the R2D was 0.305.The 5-year incidence of AF structural remodeling in the high-risk group was significantly higher than that in the medium and low-risk groups(42.80％vs.21.30％vs.11.30％,P＜0.001).The enhanced model C statistic was increased to 0.800,R2D was 0.347,and the incidence of high-risk group was further significantly increased(49.80％vs.25.60％vs.8.90％,P＜0.001).The original CHARGE-AF model shows poor calibration and underestimates the actual risk when predicting the 5-year AF risk.When the predicted risk is 20％,the actual risk is higher than the predicted value;the Greenwood-Nam-D'Agostino test showed significant calibration errors(x2=15.632,P＜0.001),the optimistic estimate was 0.235,and the adjusted C statistic was 0.620.The CHARGE-AF enhanced model showed good calibration,and the prediction was close to the actual risk curve.The Greenwood-Nam-D'Agostino test showed no significant calibration error(P=0.078),the optimistic estimate was 0.085,and the adjusted C statistic was 0.780.Conclusions Serum UA and TGF-β2 are closely related to the risk of AF structural remodeling in patients with HFpEF combined with AF.Compared with the original Chart-AF model,the Chart-AF enhanced model has better discriminatory ability,predictive ability and calibration in evaluating the risk of AF structural remodeling.