Abstract
Background
High-sensitivity cardiac troponin (hs-cTnT) is often increased in patients with atrial
fibrillation/flutter, portending a poor prognosis. The etiologies for these increases
have not been systematically investigated. Our aim was to define prevalence/significance
of structural cardiac abnormalities in patients with atrial fibrillation/flutter and
high-sensitivity cardiac troponin T (hs-cTnT) increases.
Methods
This is a retrospective observational cohort study of patients with atrial fibrillation/flutter
diagnosis with hs-cTnT measurements, echocardiograms, and coronary angiograms. Myocardial
injury was defined as hs-cTnT >10 ng/L for women and >15 ng/L for men. Cases with
myocardial injury were adjudicated according to the Fourth Universal Definition of
Myocardial Infarction.
Results
Patients with definite causes for increased hs-cTnT (n = 875) were tabulated but not
evaluated further; common diagnoses were type 1 myocardial infarction, critical illness,
and known heart failure. Of the remaining 401, increased hs-cTnT was present in 336
(84%) patients. Of those, 78% had nonischemic myocardial injury, the remaining (n = 75,
22%) had type 2 myocardial infarction. Patients with elevated hs-cTnT had greater
left ventricular mass index, left ventricular filling pressures, and right ventricular
systolic pressure. They more frequently had significant coronary artery disease (47%
vs 31%, P = .016), especially in type 2 myocardial infarction. With logistic regression, age,
sex (F), diabetes, left ventricular mass index, e′ medial velocity, and right ventricular
systolic pressure were independent determinants of myocardial injury. One-year mortality
was higher in patients with myocardial injury.
Conclusions
Structural heart abnormalities are common in patients with atrial fibrillation/flutter
and increased hs-cTnT. Causes of myocardial injury should be elucidated in each patient
to craft appropriate therapies.
Keywords
Abbreviations:
ED (emergency department), cTn (cardiac troponin), hs (high sensitivity)To read this article in full you will need to make a payment
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Article Info
Publication History
Published online: July 10, 2022
Publication stage
In Press Journal Pre-ProofFootnotes
Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Conflicts of Interest: YS has previously served on the Advisory Boards for Roche Diagnostics and Abbott Diagnostics without personal compensation. He has also been a speaker without personal financial compensation for Abbott Diagnostics. ASJ has consulted or presently consults for most of the major diagnostics companies, including Beckman-Coulter, Abbott, Siemens, Ortho Diagnostics, ET Healthcare, Roche, Radiometer, Sphingotec, RCE, Amgen, and Novartis. The other authors have nothing to disclose.
Authorship: LDM: Conceptualization, investigation, data curation, writing – original draft preparation; RL: Investigation, data curation, writing – reviewing and editing; LB: Conceptualization, writing – reviewing and editing; RMM: Conceptualization, writing – reviewing and editing; SI: Writing – reviewing and editing; AP: Investigation, data curation, writing – reviewing and editing; YS: Investigation, data curation, writing – reviewing and editing; ASJ: Conceptualization, supervision, data curation, writing – reviewing and editing.
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