Circulating transthyretin with atrial morpho-functional phenotypes and atrial fibrillation risk, and the modifying role of BMI

作者：Nan Zhang, Ziheng Jia, Jinhua Zhao, Xuyao Han, Jie Liu, Gary Tse, Jiandong Zhou, Kang‐Yin Chen, Gregory Y.H. Lip, Tong Liu · 发表于：BMC Medicine · 年份：2025 · DOI：10.1186/s12916-025-04391-6 · 被引用次数：2 · 研究领域：Amyloidosis: Diagnosis, Treatment, Outcomes、Parathyroid Disorders and Treatments、Dermatological and Skeletal Disorders

Low circulating transthyretin (TTR) concentration has been suggested as a biomarker of transthyretin tetramer instability, a prerequisite for the development of transthyretin cardiac amyloidosis. This study aimed to evaluate the associations between circulating TTR levels with incident atrial fibrillation (AF) and other arrhythmias. This study used data from the UK Biobank. Participants with available TTR data and without prior arrhythmias were included. The primary outcome was new-onset AF. The secondary outcomes were new-onset supraventricular arrhythmias (SVA), bradyarrhythmias, cardiac block, and ventricular arrhythmias (VA). Multivariable Cox regression was applied to evaluate the associations between circulating TTR levels with arrhythmia outcomes. A total of 40,723 participants (mean age 56.7 ± 8.2 years; 55% women) were included. After adjusting for potential confounders, one standard deviation (SD) decrease in TTR levels was associated with an increased risk of incident AF (HR 1.06, 95% CI 1.02–1.11). Furthermore, significant associations between low TTR with atrial structural remodeling were observed, manifesting as increased left atrial volume index (β 0.51, 95% CI 0.09–0.92) and right atrial volume index (β 0.87, 95% CI 0.39–1.40). In addition, there was a significant association between lower TTR levels with higher incident SVA risk, but not for bradyarrhythmias, cardiac block, or VA. A consistently significant interaction effect was identified between TTR levels...