N-acetyl-beta-D-glucosaminidase and kidney injury molecule 1: detection of potential tubular injury in atrial fibrillation

Abstract Introduction Acute heart disorders are often associated with an already present atrial fibrillation and cardiorenal syndrome in the emergency department (ED). This study focused on evaluating the potential cardiorenal biomarkers N-acetyl-β-D-glucosaminidase (NAG) and kidney injury molecule 1 (KIM) in a real-world chest pain cohort according to sinus rhythm (SR) and atrial fibrillation (AFib). Methods The urinary concentrations of the tubular markers NAG and KIM were measured in 601 samples (mean age = 61.1 y, SD = 16.9 y) of patients presenting with acute chest pain in the ED of a university hospital. 533 patients presented with SR in the initial ECG upon hospital admission contrary to 68 patients presenting with AFib. The participants were divided into 4 groups based on their diagnosis for hospitalization, Acute coronary syndrome (ACS), acute decompensated heart failure (ADHF), non-ischemic chest pain without congestion (NICP) and chest-wall-syndrome (CWS). The CWS group only included healthy patients presenting with SR. Results Significantly increased NAG and KIM concentrations were identified among the patients presenting with AFib compared to those presenting with SR (each p < 0.001, AUCNAG = 0.730, AUCKIM = 0.634). Furthermore, ACS patients showed significantly increased tubular biomarker concentrations when presenting with AFib compared to SR (each p < 0.05). Similarly, for NICP patients significantly elevated NAG-concentrations were measured (p < 0.001), opposite to KIM (p = n. s.). Regarding ADHF, the concentration of NAG did not significantly differ between AFib and SR. However, KIM concentrations were significantly reduced in AFib. Both, NAG and KIM showed significantly higher concentrations in ACS or ADHF compared to CWS patients (p < 0.001). Regarding multivariate linear binary regression, NAG was an independent predictor of AFib (p < 0.001), contrary to KIM, blood NT-proBNP and high-sensitivity troponin T, blood creatinine (each p = n. s.). Conclusion Both, NAG and to a lesser extent KIM correlate with AFib. This finding implies significantly higher tubular injury in acute heart diseases among individuals beating in AFib compared to those in SR. Hence, AFib may have a high impact on renal function and the cardiorenal syndrome in ACS-patients.ROC-Curve comparing AFib and SR overallNAG in AFib and SR according to disease