Dynamic high-sensitivity troponin elevations in atrial fibrillation patients might not be associated with significant
Johan Thelin1,2, Olle Melander3,4,5
1Department of Clinical Sciences, Lund University, Lund, Sweden. johan.thelin@skane.se.
Insights
Dynamic troponin elevations in atrial fibrillation (AF) patients without coronary artery disease (CAD) may not increase cardiac event risk but are linked to higher all-cause mortality.
Area of Science:
- Cardiology
- Biomarkers
- Clinical Medicine
Background:
- High-sensitivity troponin assays reveal dynamic troponin elevations in a growing number of atrial fibrillation (AF) patients.
- A hypothesis suggests significant coronary artery disease (CAD) causes relative ischemia during rapid heart rates, leading to dynamic troponin elevation.
- This study investigates the cardiac event risk in AF patients with tachycardia and dynamic troponin changes but no known CAD.
Purpose of the Study:
- To determine if AF patients with tachycardia and dynamic high-sensitivity troponin T (hsTnT) changes, without prior CAD diagnosis, face an elevated risk of cardiac events.
- To analyze the association between dynamic hsTnT elevation and adverse cardiac outcomes, including acute coronary syndrome, revascularization, and ischemic heart disease-related death.
- To evaluate the prognostic value of dynamic hsTnT elevation in predicting all-cause mortality in this patient cohort.
Main Methods:
- Retrospective analysis of AF patients presenting with tachycardia over a one-year period.
- Inclusion criteria: absence of known CAD, presence of AF and tachycardia.
- Primary endpoint assessment: acute coronary syndrome, revascularization, or death from ischemic heart disease within 30 months.
Main Results:
- Of 522 patients without known CAD, 49 (9.5%) exhibited dynamic hsTnT elevation.
- Patients with dynamic hsTnT elevation showed a higher rate of all-cause mortality (25%) compared to those with normal hsTnT (4.7%).
- The age-adjusted hazard ratio for all-cause mortality was significantly higher (3.8; p=0.001) in the dynamic hsTnT group, while the risk for the primary endpoint was not significantly increased (HR=1.9; p=0.28).
Conclusions:
- Dynamic hsTnT elevation in AF patients without known CAD may not signify a substantially increased risk of coronary events.
- However, dynamic hsTnT elevation in this context is a significant indicator of increased all-cause mortality.
- Further research may clarify the underlying mechanisms and clinical implications of dynamic troponin changes in AF patients.
Background:
Since the introduction of high-sensitivity troponin assays a greater proportion of atrial fibrillation (AF) patients present with dynamic troponin elevations. We hypothesize that significant coronary artery disease (CAD) causes relative ischemia in the setting of a rapid heart rate resulting in dynamic troponin elevation. The aim of this study was to examine if patients without known CAD who present with AF, tachycardia and dynamic high-sensitivity troponin T (hsTnT) change have an increased risk of cardiac events.
Methods:
We retrospectively included AF patients presenting with tachycardia during one year. The primary endpoint was acute coronary syndrome, revascularization or death due to ischemic heart disease during 30 months follow-up.
Results:
Five hundred twenty-two patients without known CAD were included, 300 (57%) had normal hsTnT and 49 (9.5%) had dynamic hsTnT elevation. During follow-up 12 (4%) patients with normal hsTnT reached the primary endpoint and a total of 14 (4.7%) patients died. In the group with dynamic hsTnT the results were 4 (8.2%) and 12 (25%) respectively. The age-adjusted hazard ratio (HR) for the primary endpoint in patients with dynamic hsTnT was 1.9 (95% CI: 0.6 to 6.2; p = 0.28) and for all-cause mortality 3.8 (95% CI: 1.7 to 8.5; p = 0.001).
Conclusions:
Dynamic hsTnT elevation in connection with AF might not be associated with any major increased risk of coronary events, but indicates increased all-cause mortality.
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