Prognostic value of troponin I in atrial fibrillation,Progress in Cardiovascular Diseases

当前位置： X-MOL 学术 › Prog. Cardiovasc. Dis. › 论文详情

Our official English website, www.x-mol.net, welcomes your feedback! (Note: you will need to create a separate account there.)

Prognostic value of troponin I in atrial fibrillation
Progress in Cardiovascular Diseases ( IF 5.6 ) Pub Date : 2021-02-25 , DOI: 10.1016/j.pcad.2021.02.012
Aurelio Quesada ₁ , Lucas López-Valero ₂ , Goitzane Marcaida-Benito ₃ , Javier Jiménez Bello ₄ , Javier Quesada-Ocete ₄ , Ricardo Rubini-Costa ₅ , Blanca Quesada-Ocete ₆ , Ricardo Rubini-Puig ₇ , Angeles Férez-Martí ₃ , Victor Del Moral-Ronda ₈ , Victor Palanca-Gil ₄ , Fernando de la Guía-Galipienso ₉ , Carl J Lavie ₁₀ , Giuseppe Lippi ₁₁ , Fabian Sanchis-Gomar ₁₂

Affiliation

From the Arrhythmia Unit, Cardiology Service, General University Hospital Consortium of Valencia, Valencia, Spain; School of Medicine, Catholic University of Valencia San Vicente Mártir, Valencia, Spain.
School of Medicine, Catholic University of Valencia San Vicente Mártir, Valencia, Spain.
Laboratory Medicine Service, General University Hospital Consortium of Valencia, Valencia, Spain.
From the Arrhythmia Unit, Cardiology Service, General University Hospital Consortium of Valencia, Valencia, Spain.
Department of Cardiology, Hospital Virgen de las Nieves, Granada, Spain.
Department of Cardiology II/Electrophysiology, Center of Cardiology, University Medical Center, Johannes Gutenberg-University Mainz, Germany.
Emergency Room Department, General University Hospital Consortium of Valencia, Valencia, Spain.
Department of Cardiology, Hospital Universitario de Tarragona Joan XXVIII, Tarragona, Spain.
Cardiology Service of Marina Baixa Hospital, Alicante, Spain.
John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA, USA.
Section of Clinical Biochemistry, University of Verona, Verona, Italy.
Department of Physiology, School of Medicine, University of Valencia and INCLIVA Biomedical Research Institute, Valencia, Spain.

Objective

To evaluate whether circulating cardiac troponin I (cTnI) levels are associated with worst outcomes in patients with atrial fibrillation (AF).

Methods

Consecutive patients visiting the emergency room (ER) with a new episode of a previously diagnosed AF or a new diagnosis of AF during ER admission between January 1st, 2010 and December 31st, 2015, were enrolled in the study (n = 2617). After applying exclusion criteria and eliminating repeated episodes, 2013 patients were finally included. Of these, 1080 patients with at least one cTnI measurement in the ER were selected and classified into 4 groups according to cTnI quartiles: Q1 (n = 147) cTnI <10 ng/L (Group 1); Q2 (n = 254): 10–19 ng/L (Group 2); Q3 (n = 409): 20–40 ng/L (Group 3); and Q4 (n = 270): cTnI >40 ng/L (Group 4). The median follow-up period was 47.8 ± 32.8 months. The primary endpoint was all-cause death during the follow-up.

Results

A higher mortality was found in group 4 compared with the other groups (58.9% vs. 28.5%, respectively, p < 0.001), along with, hospitalizations (40.4% vs. 30.7%, p = 0.004), and readmissions due to decompensated heart failure (26.7% vs. 2.5%, p = 0.002). The probability of survival without AF recurrences was lower in the Q4 (p = 0.045). Moreover, cTnI levels >40 ng/L (Q4) were an independent risk factor of death (HR, 2.03; 95% CI, 1.64–2.51; p < 0.001).

Conclusion

The assessment of cTnI at ER admission could be a useful strategy for risk stratification of patients diagnosed with AF by identifying a subgroup with medium-term to long-term increased risk of adverse events and mortality.

中文翻译：

肌钙蛋白 I 在心房颤动中的预后价值

客观的

评估循环心肌肌钙蛋白 I (cTnI) 水平是否与心房颤动 (AF) 患者的最差结果相关。

方法

本研究招募了在 2010 年 1 月 1 日至 2015 年 12 月 31 日期间因先前诊断出的 AF 新发作或在 ER 入院期间新诊断出的 AF 连续进入急诊室 (ER) 的患者 ( n = 2617)。在应用排除标准并消除重复发作后，最终纳入了 2013 名患者。其中，选择了 1080 名在 ER 中至少有一次 cTnI 测量值的患者，并根据 cTnI 四分位数分为 4 组：Q1 ( n = 147) cTnI <10 ng/L（组 1）；Q2 ( n = 254)：10–19 ng/L（第 2 组）；Q3 ( n = 409)：20–40 ng/L（第 3 组）；和 Q4 ( n = 270)：cTnI >40 ng/L（第 4 组）。中位随访时间为 47.8 ± 32.8 个月。主要终点是随访期间的全因死亡。

结果

与其他组相比，第 4 组的死亡率更高（分别为58.9%和28.5%，p < 0.001），住院率更高（40.4%对30.7%，p = 0.004），以及因失代偿导致的再入院心力衰竭（26.7%对2.5%，p = 0.002）。第 4 季度无房颤复发的生存概率较低 ( p = 0.045)。此外，cTnI 水平 >40 ng/L (Q4) 是死亡的独立危险因素（HR，2.03；95% CI，1.64–2.51；p < 0.001）。