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High-Sensitivity Cardiac Troponin as a Predictor of Atrial Fibrillation Detected After Stroke: Implications for
Bum Sung Kim1, Jung Jin Park2, Ji-Hoon Choi1
1Division of Cardiology, Department of Medicine, Konkuk University Medical Center, 120-1 Neungdong-ro, Gwangjin-gu, Seoul 05030, Republic of Korea.
Insights
Newly detected atrial fibrillation (AF) after stroke, termed AFDAS, carries similar risks of major adverse cardiac and cerebrovascular events as known AF. Elevated high-sensitivity cardiac troponin I (hs-TnI) predicts AFDAS development in stroke patients.
Area of Science:
- Cardiology
- Neurology
- Biomarkers
Background:
- Atrial fibrillation (AF) detection post-stroke is inconsistent in prognostic implications compared to known AF.
- High-sensitivity cardiac troponin (hs-cTn) role in predicting new-onset AF after stroke is unclear.
- Understanding AF detection post-stroke is crucial for managing cerebrocardiovascular risk.
Purpose of the Study:
- Evaluate high-sensitivity cardiac troponin I (hs-TnI) as a predictor for AF detected after stroke (AFDAS).
- Compare outcomes including death, heart failure (HF), and stroke readmissions among patients with non-AF, AFDAS, and known AF.
- Assess the prognostic value of hs-TnI in stratifying risk after ischemic stroke.
Main Methods:
- Retrospective analysis of 1019 acute ischemic stroke patients from August 2014 to July 2017.
- Primary outcome: Major Adverse Cardiac and Cerebrovascular Events (MACCE), a composite of death, HF, or stroke readmission.
- Independent predictors for AFDAS and comparative outcome analysis between AF groups and non-AF group.
Main Results:
- 13.8% of patients developed AFDAS over a median of 22.5 months.
- Elevated hs-TnI, advanced age (>75), and increased left atrial volume index independently predicted AFDAS.
- Both AFDAS and known AF significantly increased MACCE risk versus non-AF; risks did not differ between AFDAS and known AF groups.
Conclusions:
- Elevated hs-TnI is an independent predictor of AFDAS in ischemic stroke patients.
- hs-TnI may help stratify risk for future cerebrocardiovascular events post-stroke.
- AFDAS and known AF confer similar risks for MACCE, highlighting the importance of AF detection after stroke.
Abstract:
Background: Atrial fibrillation (AF) may be detected at the time of ischemic stroke or newly detected after stroke. While AF detected after stroke (AFDAS) is associated with poor outcomes compared to sinus rhythm, its prognostic implications relative to known-AF are inconsistent. High-sensitivity cardiac troponin (hs-cTn) is a biomarker of myocardial injury, but its role in predicting AFDAS in stroke patients is unclear. We aimed to evaluate hs-cTn as a predictor for AFDAS and to compare all-cause death, readmission for heart failure (HF) and readmission for stroke among patients with non-AF, AFDAS, and known-AF in the post-ischemic stroke period. Methods: From August 2014 to July 2017, 1506 patients with acute ischemic stroke were consecutively enrolled in a retrospective single-center registry. Out of these, 1019 patients were selected for analysis. The primary outcome was major adverse cardiac and cerebrovascular events (MACCE), a composite of all-cause death, HF-caused readmission, or stroke-caused readmission during follow-up. Results: Out of 1019 ischemic stroke patients, 121 (13.8%) developed AFDAS over a median of 22.5 months; 135 had known-AF and 763 were maintained sinus rhythm during follow-up. Elevated hs-TnI (≥99th percentile), age > 75, and left atrial volume index >34 mL/m2 independently predicted AFDAS. Both AFDAS and known-AF groups had a significantly increased risk of MACCE compared to the non-AF group (adjusted hazard ratio (HR) 1.85 and 1.76, respectively; p < 0.05 for both). The known-AF group also had a higher risk of all-cause mortality (adjusted HR 2.05, p = 0.02). The risks for MACCE and all-cause death did not differ significantly between the AFDAS and known-AF groups. Conclusions: An elevated hs-TnI level is independently associated with development of AFDAS and may serve as a valuable marker for stratifying the risk of future cerebrocardiovascular events following ischemic stroke.
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