Identifying High-Risk Atrial Fibrillation in Diabetes: Evidence from Nomogram and Plasma Metabolomics Analysis

Area of Science:

• Cardiology
• Endocrinology
• Metabolomics

Background:

• Diabetes mellitus is a significant risk factor for atrial fibrillation (AF).
• Accurate risk stratification for AF in diabetic patients remains a clinical challenge.
• Understanding the interplay between diabetes, AF, and metabolic pathways is crucial.

Purpose of the Study:

• To develop and validate a clinical risk score for AF in diabetic patients.
• To investigate the metabolic profiles associated with AF in diabetes using untargeted metabolomics.
• To improve AF risk stratification and personalized management strategies for diabetic individuals.

Main Methods:

• Development and validation of a clinical risk score using NHANES and Tongji Hospital cohorts.
• Assessment of the risk score's association with long-term outcomes and AF recurrence post-ablation.
• Untargeted plasma metabolomic analysis in diabetic patients with and without AF to identify mechanistic insights.

Main Results:

• The developed clinical risk score demonstrated good predictive performance and prognostic value.
• Combining the risk score with left atrial diameter and AF type enhanced prediction of AF recurrence.
• Metabolomic profiling revealed distinct metabolic disturbances in diabetic AF patients, including altered energy metabolism, inflammation, and stress responses.

Conclusions:

• Two novel approaches, clinical modeling and metabolomics, were presented for identifying high-risk AF in diabetic patients.
• The study elucidated potential pathophysiological mechanisms linking diabetes and AF through metabolic alterations.
• Integrated strategies combining clinical and metabolomic data can significantly improve AF risk stratification and personalized care in the diabetic population.