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Structural Cardiac Abnormalities in Patients with Atrial Fibrillation/Flutter and Myocardial Injury

Laura De Michieli1, Ronstan Lobo2, Luciano Babuin3

  • 1Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA; Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Italy.

The American Journal of Medicine
|July 13, 2022
PubMed

Insights

Elevated high-sensitivity cardiac troponin T (hs-cTnT) in atrial fibrillation/flutter patients often indicates underlying structural heart issues. Identifying these causes is crucial for effective treatment and improved patient prognosis.

Area of Science:

  • Cardiology
  • Biomarkers
  • Cardiac Electrophysiology

Background:

  • Elevated high-sensitivity cardiac troponin T (hs-cTnT) is a common finding in patients diagnosed with atrial fibrillation/flutter.
  • This elevation is associated with a poorer prognosis, but the underlying causes remain under-investigated.
  • Understanding the reasons for increased hs-cTnT is critical for managing these patients.

Purpose of the Study:

  • To investigate the prevalence and significance of structural cardiac abnormalities in patients with atrial fibrillation/flutter and elevated hs-cTnT.
  • To define the specific etiologies contributing to increased hs-cTnT levels in this patient cohort.

Main Methods:

  • A retrospective observational cohort study was conducted.
  • Patients with atrial fibrillation/flutter and hs-cTnT measurements, echocardiograms, and coronary angiograms were included.
  • Myocardial injury was defined by hs-cTnT levels exceeding specific thresholds for sex, with adjudication based on the Fourth Universal Definition of Myocardial Infarction.

Main Results:

  • Of 401 patients without definite causes for elevated hs-cTnT, 336 (84%) had increased levels.
  • The majority (78%) of these cases involved nonischemic myocardial injury, with 22% classified as type 2 myocardial infarction.
  • Patients with elevated hs-cTnT exhibited greater left ventricular mass index, filling pressures, and right ventricular systolic pressure, along with a higher incidence of significant coronary artery disease.

Conclusions:

  • Structural heart abnormalities are frequently observed in patients with atrial fibrillation/flutter and elevated hs-cTnT.
  • Thorough elucidation of myocardial injury causes is essential for tailoring appropriate therapeutic strategies.
  • Identifying specific etiologies can guide targeted interventions to improve outcomes in this high-risk population.
Abstract

Keywords:
Atrial fibrillation/flutterHigh-sensitivity cardiac troponin TMyocardial infarctionMyocardial injuryPrognosis

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