Structural Cardiac Abnormalities in Patients with Atrial Fibrillation/Flutter and Myocardial Injury - 17/11/22
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.
Le texte complet de cet article est disponible en PDF.Keywords : Atrial fibrillation/flutter, High-sensitivity cardiac troponin T, Myocardial infarction, Myocardial injury, Prognosis
Abbreviations : ED, cTn, hs
Plan
| Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. |
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| 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. |
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| 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. |
Vol 135 - N° 12
P. 1488 - décembre 2022 Retour au numéro
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