Associations between plasma proteomic profiles and subclinical variations in left atrial strain in adults without overt cardiovascular disease: the role of cardiometabolic factors.

INTRODUCTION

Associations between plasma proteomic profiles and left atrial strain (LAS) may provide insights into biological processes that underly variations in atrial function in adults without overt cardiovascular disease (CVD).

OBJECTIVES

We aimed to assess the associations between circulating proteins and phasic LAS, and explore the potential influence of cardiometabolic factors on these relationships.

PATIENTS AND

METHODS

Study participants included individuals from the population of the Bialystok PLUS (Bialystok Polish Longitudinal University Study), examined between 2018 and 2024, including adults aged 35-70 years who had complete echocardiographic data and plasma samples available for proteomic profiling. Individuals with overt cardiovascular, inflammatory, neoplastic, or neurodegenerative disease were excluded. LA reservoir (LASr), conduit (LAScd), and contraction (LASct) strains were assessed on speckle‑tracking echocardiography. Plasma proteomic profiling was performed using the Olink Reveal platform. The associations between 1034 proteins and LAS parameters were analyzed using age‑adjusted linear models with false discovery rate (FDR) correction (q ≤0.1). Additional analyses evaluated the influence of cardiometabolic risk factors and overlap with conventional echocardiographic parameters.

RESULTS

The study included 414 adults at a median (interquartile range) age of 51 (43-61) years; 47.3% were men. After age adjustment, significant associations were observed exclusively for LAScd, with 30 proteins meeting the FDR threshold, whereas no proteins showed associations with LASr or LASct. The proteins linked to LAScd were mainly involved in metabolic regulation, inflammation, cellular stress responses, and tissue remodeling. The proteomic signature of LAScd showed only partial overlap with conventional echocardiographic phenotypes. After further adjustment for cardiometabolic risk factors, no associations remained significant after FDR correction.

CONCLUSIONS

In adults without overt CVD, LAScd was the only component of LAS associated with a distinct age‑adjusted plasma proteomic profile. The observed associations were substantially influenced by cardiometabolic risk factors, suggesting that the identified proteomic patterns primarily reflect underlying cardiometabolic processes. Further longitudinal studies are needed to determine the clinical significance of these findings.