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Published on: July 20, 2022
Prognostic value of troponin I in atrial fibrillation
Aurelio Quesada1, Lucas López-Valero2, Goitzane Marcaida-Benito3
1From the Arrhythmia Unit, Cardiology Service, General University Hospital Consortium of Valencia, Valencia, Spain; School of Medicine, Catholic University of Valencia San Vicente Mártir, Valencia, Spain.
Insights
Elevated cardiac troponin I (cTnI) levels in atrial fibrillation (AF) patients presenting to the emergency room indicate a higher risk of death and adverse events. This biomarker aids in identifying high-risk AF patients for better management.
Area of Science:
- Cardiology
- Biomarkers
- Emergency Medicine
Background:
- Atrial fibrillation (AF) is a common arrhythmia associated with significant morbidity and mortality.
- Cardiac troponin I (cTnI) is a marker of myocardial injury, but its role in AF patients without acute coronary syndrome is less defined.
Purpose of the Study:
- To investigate the association between circulating cardiac troponin I (cTnI) levels and adverse outcomes in patients with atrial fibrillation (AF).
- To determine if cTnI can serve as a prognostic biomarker for risk stratification in AF patients.
Main Methods:
- A cohort of 2013 patients with new-onset or previously diagnosed AF admitted to the emergency room (ER) between 2010 and 2015 was analyzed.
- Patients were stratified into four groups based on cTnI levels (quartiles), with follow-up for mortality, hospitalizations, and heart failure readmissions.
Main Results:
- Patients in the highest cTnI quartile (>40 ng/L) exhibited significantly higher all-cause mortality (58.9% vs. 28.5%) compared to lower quartiles.
- Elevated cTnI levels were associated with increased hospitalizations, heart failure readmissions, and a lower probability of survival without AF recurrence.
- cTnI levels >40 ng/L were identified as an independent risk factor for death (HR, 2.03).
Conclusions:
- Emergency room assessment of cTnI levels can effectively stratify risk in AF patients.
- Identifying patients with elevated cTnI can pinpoint a subgroup at increased medium- to long-term risk of adverse events and mortality.
- cTnI measurement offers a valuable tool for improving prognostic accuracy and guiding management strategies in AF.
Objective:
To evaluate whether circulating cardiac troponin I (cTnI) levels are associated with worst outcomes in patients with atrial fibrillation (AF).
Methods:
Consecutive patients visiting the emergency room (ER) with a new episode of a previously diagnosed AF or a new diagnosis of AF during ER admission between January 1st, 2010 and December 31st, 2015, were enrolled in the study (n = 2617). After applying exclusion criteria and eliminating repeated episodes, 2013 patients were finally included. Of these, 1080 patients with at least one cTnI measurement in the ER were selected and classified into 4 groups according to cTnI quartiles: Q1 (n = 147) cTnI <10 ng/L (Group 1); Q2 (n = 254): 10-19 ng/L (Group 2); Q3 (n = 409): 20-40 ng/L (Group 3); and Q4 (n = 270): cTnI >40 ng/L (Group 4). The median follow-up period was 47.8 ± 32.8 months. The primary endpoint was all-cause death during the follow-up.
Results:
A higher mortality was found in group 4 compared with the other groups (58.9% vs. 28.5%, respectively, p < 0.001), along with, hospitalizations (40.4% vs. 30.7%, p = 0.004), and readmissions due to decompensated heart failure (26.7% vs. 2.5%, p = 0.002). The probability of survival without AF recurrences was lower in the Q4 (p = 0.045). Moreover, cTnI levels >40 ng/L (Q4) were an independent risk factor of death (HR, 2.03; 95% CI, 1.64-2.51; p < 0.001).
Conclusion:
The assessment of cTnI at ER admission could be a useful strategy for risk stratification of patients diagnosed with AF by identifying a subgroup with medium-term to long-term increased risk of adverse events and mortality.
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