High sensitivity cardiac troponin T and interleukin‐6 predict adverse cardiovascular events and mortality in anticoagulated patients with atrial fibrillation

Abstract

To cite this article: Roldá n V, Marín F, Díaz J, Gallego P, Jover E, Romera M, Manzano-Ferná ndez S, Casas T, Valdé s M, Vicente V, Lip GYH. High sensitivity cardiac troponin T and interleukin-6 predict adverse cardiovascular events and mortality in anticoagulated patients with atrial fibrillation.J Thromb Haemost 2012; 10: 1500-7.Summary. There are limited data on the prognostic role of biomarkers in anticoagulated patients with atrial fibrillation (AF). We evaluated the prognostic value of high sensitivity TnT (hsTnT) and high-sensitivity interleukin-6 (hsIL6) in a large cohort of AF patients taking oral anticoagulant therapy (OAC) as both biomarkers have been associated with adverse cardiovascular events. Methods: We studied 930 patients (51% male; median age 76) with permanent/ paroxysmal AF who were stabilized (for at least 6 months) on OAC (INRs 2.0-3.0). Plasma hsTnT and hsIL6 levels were quantified by electrochemiluminescense immunoassay at baseline. Patients were followed-up for up to 2 years, and adverse events (thrombotic and vascular events, mortality and major bleeding) were recorded. Results: At follow-up, 96 patients (3.97%/year) died whilst 107 had an adverse cardiovascular event (3.14%/year). On multivariate analysis, high hsTnT and high hsIL6 remained significantly associated with prognosis even after adjusting for CHADS 2 score: HR 2.21 (1.46-3.35, P < 0.001) for high hsTnT and 1.97 (1.29-3.02, P = 0.002) for high hsIL6, for adverse cardiovascular events. For all-cause mortality, the HRs were 1.79 (1.13-2.83, P = 0.013) and 2.48 (1.60-3.85, P < 0.001), respectively. The integrated discrimination index (IDI) values of clinical scores (CHADS 2 and CHA 2 DS 2 -VASc) were improved by the addition of hsTnT and/or hsIL6 (all P < 0.05). Conclusion: In a large Ôreal worldÕ cohort of anticoagulated AF patients, both hsTnT and hsIL6 levels provided prognostic information that was complementary to clinical risk scores for prediction of long-term cardiovascular events and death, suggesting that these biomarkers may potentially be used to refine clinical risk stratification in AF.

The Significance Of Troponin Elevation In Atrial Fibrillation

“…Adding hs-cTnT levels to the CHA 2 DS 2 VASc score improved the C statistic from 0.620 to 0.635 for stroke or systemic embolism (p = 0.0226), from 0.592 to 0.711 for cardiac death (p < 0.0001), and from 0.591 to 0.629 for major bleeding (p < 0.0001) [7]. These results were confirmed in the study by Roldan et al [25] , in a stable and chronic anticoagulated AF cohort, whereby increased plasma hs-cTnT levels were associated with an adverse prognosis in AF patients, with regard to cardiovascular events and mortality. Patients with levels above the 50th percentile of the troponin distribution in an AF population had an increased risk of stroke, other ischemic events, and a higher mortality regardless of their risk as estimated by the CHADS 2 and CHA 2 DS 2 -VASc scores.…”

Application of Cardiac Troponin in Cardiovascular Diseases Other Than Acute Coronary Syndrome

“…Cardiac troponin above the detection limit predicted mortality and stroke or systemic embolism in both studies, independent of other biomarkers or the CHA 2 DS 2 -VASc score. Similar findings have been reported from a registry cohort of anticoagulated AF patients (34 ). A detailed review regarding the implications of cardiac troponin in AF is presented by Hijazi et al in this issue of Clinical Chemistry (35 ).…”

Short-term rapid atrial pacing alters the gene expression profile of rat liver: Cardiohepatic interaction in atrial fibrillation

“…[28][29][30] Additionally, in a large cohort of anticoagulated permanent/paroxysmal AF patients, serum IL-6 level was an independent predictor of cardiovascular events and death, and the addition of IL-6 resulted in improved prediction performance of the CHA2DS2-VASc clinical risk stratification schemes. 31 These observations support the idea that IL-6 is involved in the pathogenesis of AF and AF-related thromboembolism.…”