Objective To investigate the association between serum direct bilirubin (DBIL) combined with uric acid (UA) and left atrial remodeling in patients with heart failure with preserved ejection fraction (HFpEF) complicated by atrial fibrillation (AF).
Methods Clinical data from 185 patients with HFpEF were retrospectively analyzed. Patients were stratified into three groups based on AF status: persistent AF group (n = 57, HFpEF with persistent AF), paroxysmal AF group (n = 28, HFpEF with paroxysmal AF), and non-AF group (n = 100, HFpEF without AF). Serum levels of UA, DBIL, N-terminal pro-B-type natriuretic peptide (NT-proBNP), as well as left atrial diameter (LAD), were compared across groups. Correlation and multivariate logistic regression analyses were performed to determine the relationship between UA/DBIL levels and left atrial structural (LAD) remodeling in HFpEF-AF patients. Receiver operating characteristic (ROC) curves were generated to evaluate the diagnostic value of UA and DBIL for left atrial remodeling.
Results Serum UA, DBIL, and LAD exhibited progressively increasing trends across the non-AF, paroxysmal AF, and persistent AF groups (all P ＜ 0.01). NT-proBNP levels were significantly higher in the persistent AF group than in the paroxysmal AF and non-AF groups (P ＜ 0.01), with no significant difference between paroxysmal AF and non-AF groups (P ＞ 0.05). In HFpEF-AF patients, DBIL, UA, and NT-proBNP levels showed positive correlations with LAD (r = 0.383, 0.447, and 0.308, all P ＜ 0.01). Multivariate analysis identified elevated UA (P ＜ 0.05) and DBIL (P ＜ 0.01) as independent risk factors for atrial remodeling, whereas NT-proBNP was not (P ＞ 0.05). The combination of UA and DBIL yielded an AUC of 0.760 (sensitivity 83.70%, specificity 58.30%) for diagnosing left atrial remodeling in HFpEF-AF patients.
Conclusions Serum UA and DBIL levels are significantly elevated in HFpEF-AF patients and are positively correlated with LAD, a marker of left atrial remodeling. These biomarkers may serve as potential diagnostic indicators for left atrial remodeling in this patient population. Furthermore, DBIL may contribute to left atrial remodeling by influencing the progression of HFpEF, thereby promoting the occurrence and progression of AF.
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