Prognostic value of elevated high-sensitivity cardiac troponin T in patients admitted to an emergency department with atrial fibrillation

Stoyanov, Kiril M; Giannitsis, Evangelos; Biener, Moritz; Mueller‐Hennessen, Matthias; Arens, Katharina; Katus, Hugo A.; Vafaie, Mehrshad

doi:10.1093/europace/eux063

Cited by 17 publications

(11 citation statements)

References 20 publications

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“…* Medical record software not in use from 11 November 2011 to 9 December 2011 AF denotes atrial fibrillation, hsTnT high-sensitivity troponin T. (Reproduced with permission from Oxford University Press [18]).…”

Section: Methodsmentioning

confidence: 99%

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High-sensitivity cardiac troponin T as an independent predictor of stroke in patients admitted to an emergency department with atrial fibrillation

et al. 2019

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Aims Elevated levels of high-sensitivity cardiac troponin T (hsTnT) are associated with adverse outcomes in numerous patient populations. Their value in prediction of stroke risk in patients with atrial fibrillation (AF) is in debate. Methods The study population included 2898 consecutive patients presenting with AF to the emergency department of the Department of Cardiology, Heidelberg University Hospital. Associations between hsTnT and stroke risk were assessed using multivariable Cox regression. Results Elevated hsTnT levels (>14 ng/L) were associated with increased risk of stroke. Even after adjustment for various risk factors, elevated hsTnT remained independently associated with stroke risk in patients with AF, adjusted hazard ratio 2.35 [95% confidence interval (CI): 1.26–4.36] (P = 0.007). These results were consistent across important subgroups (age, renal function, ejection fraction, CHA 2 DS 2 -VASc score and main admission diagnosis). For hsTnT, area under the receiver-operating-characteristic curve (AUC) was 0.659 [95% CI: 0.575–0.742], compared to 0.610 [95% CI: 0.526–0.694] for the CHA 2 DS 2 -VASc score. Inclusion of hsTnT in the multivariable model for stroke risk prediction consisting of all variables of the CHA 2 DS 2 -VASc score was associated with a significant improvement of its discriminatory power. Conclusion Elevated hsTnT levels are significantly associated with higher risk of stroke and provide prognostic information independent of CHA 2 DS 2 -VASc score variables. Measurement of hsTnT may improve prediction of stroke risk in patients presenting to an emergency department with AF as compared to risk stratification based only on clinical variables.

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Section: Methodsmentioning

confidence: 99%

“…Recently, novel risk scores for patients with AF using biomarkers have been derived from RCT populations [15–17]. In the setting of an emergency department, we have shown, that elevated cardiac troponin levels are associated with higher mortality in patients with AF [18].…”

Section: Introductionmentioning

confidence: 99%

High-sensitivity cardiac troponin T as an independent predictor of stroke in patients admitted to an emergency department with atrial fibrillation

et al. 2019

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“…Explanatory factors were selected by examining the multicollinearity among the variables using stepwise regression; four factors (CHADS 2 score, whole blood passage time, d-ROMs test, and hs-cTnT level) were identified as independent variables. Figure 3 shows the receiver-operating characteristic curve analysis for the detection of high CHADS 2 scores (≥ 2) and elevated hs-cTnT levels (> 0.014 ng/mL), based on previous studies [22, 23]. The maximum Youden’s index indicated that the optimal cutoff values of skin autofluorescence to determine high CHADS 2 scores and elevated hs-cTnT levels were 2.6 AU and 2.7 AU, respectively.…”

Section: Resultsmentioning

confidence: 98%

“…Recent clinical studies have shown the clinical importance of hs-cTnT levels as a prognostic factor in patients with atrial fibrillation [23, 33]. In addition, hs-cTnT is used as a biomarker to clinically evaluate the severity of myocardial injury.…”

Section: Discussionmentioning

confidence: 99%

Clinical Significance of Skin Autofluorescence in Elderly Patients With Long-Standing Persistent Atrial Fibrillation

Hatori¹

2019

Cardiol Res

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Background Recent clinical studies have demonstrated the importance of skin autofluorescence as a cardiovascular risk factor. However, data regarding the relationship between skin autofluorescence and atrial fibrillation are limited. The aim of this study was to clarify the clinical significance of skin autofluorescence in elderly patients with long-standing persistent atrial fibrillation. Methods This cross-sectional study enrolled 112 elderly patients with long-standing persistent atrial fibrillation who were treated medically (46 men and 66 women; mean age, 81 ± 9 years). The association between skin autofluorescence and various clinical parameters was examined. Results Significant relationships were observed between skin autofluorescence and CHADS 2 score (r = 0.53, P < 0.001), high-sensitivity cardiac troponin T level (r = 0.43, P < 0.001), reactive oxygen metabolite levels (r = 0.52, P < 0.001), and whole blood passage time (r = 0.45, P < 0.001). Furthermore, multiple regression analyses showed that these clinical parameters were independent variables when skin autofluorescence was used as a subordinate factor. Receiver-operating characteristic curve analysis indicated that the risk values of skin autofluorescence for high CHADS 2 scores (≥ 2) or elevated high-sensitivity cardiac troponin T levels (> 0.014ng/mL) were 2.6 arbitrary units (AU) and 2.7 AU, respectively. Conclusions The findings of this study indicated that skin autofluorescence may be a prognostic factor in elderly patients with long-standing persistent atrial fibrillation. The risk value of skin autofluorescence was considered as 2.6 AU or 2.7 AU.

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“…Cardiac troponins are widely available in primary care and in hospitalised patients, provide plausible biological information on underlying pathophysiology, are established in the diagnosis of ACS, 1 improve risk assessment in ACS, 18 atrial fibrillation 19 and pulmonary embolism 20 and may guide therapeutic management in several acute and chronic diseases. It is tempting to speculate that a single biomarker-based risk prediction tool may be better adopted for prognostication than a complex multivariate score.…”

Section: Introductionmentioning

confidence: 99%

Risk prediction in stable cardiovascular disease using a high-sensitivity cardiac troponin T single biomarker strategy compared to the ESC-SCORE

et al. 2018

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ObjectiveTo evaluate the prognostic performance of high-sensitivity cardiac troponin T (hs-cTnT) compared with the ESC-SCORE.MethodsWe included low-risk outpatients with stable cardiovascular (CV) disease categorised into need for non-secondary and secondary prevention. The prognostication of hs-cTnT at index visit was compared with the European Society of Cardiology-Systematic COronary Risk Evaluation (ESC-SCORE) with respect to all-cause mortality (ACM) and two composite endpoints (ACM, acute myocardial infarction (AMI) and stroke and ACM, AMI, stroke and rehospitalisation for acute coronary syndrome (ACS) and decompensated heart failure (DHF)).ResultsWithin a median follow-up of 796 days, a total of 16 deaths, 32 composite endpoints of ACM, AMI and stroke and 83 composite endpoints of ACM, AMI, stroke, rehospitalisation for ACS and DHF were observed among 693 stable low-risk outpatients. Using C-statistics, measurement of hs-cTnT alone outperformed the ESC-SCORE for the prediction of ACM in the entire study population (Δarea under the curve (AUC) 0.221, p=0.0039) and both prevention groups (non-secondary: ΔAUC 0.164, p=0.0208; secondary: ΔAUC 0.264, p=0.0134). For the prediction of all other secondary endpoints, hs-cTnT was at least as effective as the ESC-SCORE, both in secondary and non-secondary prevention. Using continuous and categorical net reclassification improvement and integrated discrimination improvement, hs-cTnT significantly improved reclassification regarding all endpoints in the entire population and in the secondary prevention cohort. In non-secondary prevention, hs-cTnT improved reclassification only for ACM. The results were confirmed in an independent external cohort on 2046 patients.ConclusionsHs-cTnT is superior to the multivariable ESC-SCORE for the prediction of ACM and a composite endpoint in stable outpatients with and without relevant CV disease.Trial registration numberNCT01954303; Pre-results.

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Prognostic value of elevated high-sensitivity cardiac troponin T in patients admitted to an emergency department with atrial fibrillation

Abstract: http://www.clinicaltrials.gov; Unique identifier: NCT02542189.

Cited by 17 publications

References 20 publications

High-sensitivity cardiac troponin T as an independent predictor of stroke in patients admitted to an emergency department with atrial fibrillation

High-sensitivity cardiac troponin T as an independent predictor of stroke in patients admitted to an emergency department with atrial fibrillation

Clinical Significance of Skin Autofluorescence in Elderly Patients With Long-Standing Persistent Atrial Fibrillation

Risk prediction in stable cardiovascular disease using a high-sensitivity cardiac troponin T single biomarker strategy compared to the ESC-SCORE

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