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Risk prediction of atrial fibrillation and its complications in the community using hs troponin I

Christin S Börschel1,2, Bastiaan Geelhoed1,2, Teemu Niiranen3,4,5

  • 1Department of Cardiology, University Heart and Vascular Centre Hamburg-Eppendorf, Hamburg, Germany.

European Journal of Clinical Investigation
|January 5, 2023
PubMed

Insights

High-sensitivity troponin I (hsTnI) does not improve atrial fibrillation (AF) prediction beyond traditional risk factors. However, elevated hsTnI indicates increased risk for heart failure and mortality in AF patients.

Area of Science:

  • Cardiology
  • Biomarker research
  • Epidemiology

Background:

  • Atrial fibrillation (AF) incidence is rising, with traditional cardiovascular risk factors (CVRF) insufficient to explain all cases.
  • Blood-based biomarkers like high-sensitivity troponin I (hsTnI) may offer insights into unexplained AF development.
  • Investigating novel biomarkers is crucial for improving AF risk stratification.

Purpose of the Study:

  • To evaluate the predictive capability of hsTnI for incident AF.
  • To compare hsTnI's predictive performance against established CVRF and biomarkers.
  • To explore associations between hsTnI and related cardiovascular outcomes.

Main Methods:

  • Analysis of 45,298 participants from European community cohorts.
  • Prospective investigation of hsTnI levels for predicting incident AF over a median follow-up of 7.7 years.
  • Multivariable Cox proportional hazards models used to assess associations, adjusting for CVRF and other biomarkers.

Main Results:

  • Individuals in the highest hsTnI quartile (≥4.2 ng/L) had a 3.91-fold increased risk of developing AF.
  • A significant association was observed between hsTnI and AF incidence (HR per SD increase 1.08, p=0.03).
  • hsTnI improved model discrimination slightly (C-index 0.811 vs. 0.813, p<0.01) and was linked to heart failure and mortality.

Conclusions:

  • hsTnI, a marker of myocardial injury, does not enhance AF incidence prediction beyond CVRF and NT-proBNP.
  • Elevated hsTnI is associated with heart failure and mortality, suggesting subclinical cardiovascular impairment.
  • hsTnI may serve as an indicator of underlying cardiovascular disease burden rather than a direct predictor of AF onset.
Abstract

Keywords:
N-terminal pro B-type natriuretic peptideatrial fibrillationbiomarkersepidemiologyhigh-sensitivity troponin I

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