Cardiac troponin-I as a predictor of mortality in patients with first episode acute atrial fibrillation

Naffaa, Muhamad E; Nasser, Riwa; Manassa, E; Younis, Mohamed; Azzam, Zaher S.; Aronson, Doron

doi:10.1093/qjmed/hcx060

Cited by 11 publications

(4 citation statements)

References 17 publications

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“…Rapid ventricular rate (RVR) during AF has been defined as an average ventricular rate > 110/min in many studies [1]. The mean ventricular rate in patients with the first AF in the study by Naffaa et al [2] was 128 ± 30. AF with RVR may occur during many disorders and disease processes that may co-exist, including sepsis, hypoxia, acute heart failure, dehydration, fever, pre-excitation syndrome, and thyroid storm.…”

Section: Discussionmentioning

confidence: 99%

Migotanie przedsionków z szybką czynnością komór w czasie przełomu tarczycowego

Burakiewicz¹,

Sokołowska²,

Figuła³

et al. 2019

Folia Cardiologica

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We present the case of an unconscious 81 year-old woman admitted to the Emergency Department with fever and significant tachycardia up to 210 bpm. The patient was referred by the general physician to the neurology department with suspected stroke. Atrial fibrillation (AF) with rapid ventricular rate was found. The causes of significant tachycardia, in this case, were complex and associated with dehydration, fever, infection and thyroid storm. It could be assumed that the deterioration of the patient's general condition and a decreased fluid intake had caused hypertonic dehydration which could have led to further acceleration of the heart rhythm and loss of consciousness. Thyroid function tests are indicated in all cases of paroxysmal AF. In the presented case, the suspicion of thyroid storm was based on the results of analysis and it was confirmed later by the results of free traction of thyroid hormones' levels. The very fast ventricular rate was related to metabolic disorders and the influence of thyroid hormones on the electrophysiological properties of the atrioventricular junction. In order to stabilise the condition of the patient, passive oxygen therapy, an antipyretic drug, the correction of water and electrolyte disturbances, and digoxin were administered. This treatment improved the patient's general condition and state of consciousness, resulting in slowing heart rate and respiratory rate.

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Section: Discussionmentioning

confidence: 99%

Migotanie przedsionków z szybką czynnością komór w czasie przełomu tarczycowego

Burakiewicz¹,

Sokołowska²,

Figuła³

et al. 2019

Folia Cardiologica

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“…Cardiac troponins are often measured in patients presenting to the emergency department (ED) with symptomatic atrial fibrillation (AF) as a part of routine diagnostic workup 1,2 . Increased troponin level is a common finding in these patients, but only rarely they are suggestive of acute coronary syndrome 3‐6 . Irrespective of the cause of troponin elevation, this has been shown to be an independent risk factor for all‐cause mortality in several clinical conditions 7 .…”

Section: Introductionmentioning

confidence: 99%

“…1,2 Increased troponin level is a common finding in these patients, but only rarely they are suggestive of acute coronary syndrome. [3][4][5][6] Irrespective of the cause of troponin elevation, this has been shown to be an independent risk factor for allcause mortality in several clinical conditions. 7 Still, there are scarce data on the clinical significance of minor troponin elevation in AF patients admitted to the ED.…”

Section: Introductionmentioning

confidence: 99%

Minor troponin T elevation and mortality in patients with atrial fibrillation presenting to the emergency department

Paana

Jaakkola

Biancari

et al. 2021

Eur J Clin Investigation

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Background There are limited data on the association of minor troponin elevation in unselected patients with atrial fibrillation (AF) presenting to the emergency department (ED) with adverse events. In this study, we sought to assess the early and mid‐term mortality of these patients. Methods In this observational study, 2911 patients with AF were admitted to the ED. They were divided into 3 groups based on peak high‐sensitivity troponin (TnT) levels: normal (<15 ng/L), 15‐50 ng/L and 51‐100 ng/L. The primary outcomes of this study were all‐cause mortality at 30 days and 1 year. Results All‐cause mortality was 6.7% (n = 196) at 30 days and 22.2% (n = 646) at 1 year. Mortality rate increased along with increasing levels of TnT irrespective of baseline covariates, primary discharge diagnosis and type of AF. A significant association between TnT levels and all‐cause mortality was observed. The adjusted hazard ratio (HR) at 30 days was 6.02 (95% CI 2.62‐13.83) for TnT 15‐50 ng/L and 11.28 (95% CI 4.87‐26.12) for TnT 51‐100 ng/L (P<.001 for both) compared to TnT <15 ng/L. At 1 year, the adjusted HRs were 3.08 (95% CI 2.15‐4.40) and 5.07 (95% CI 3.49‐7.35), respectively (P < .001). When patients with TnT <15 ng/L were divided into two groups at the median value, TnT elevation of 10 to 14 ng/L was also associated with increased 1‐year mortality (HR 2.51; 95% CI 1.09‐5.74; P = .03). Conclusions Among patients with AF admitted to the ED, increased TnT levels were associated with increased early and mid‐term all‐cause mortality irrespective of baseline covariates and type of AF.

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“…Troponin elevation is common in AF [11,12,13] and patients with AF are a common patient group at the ED. Since little is known about the causes of mild troponin elevations in this scenario, we sought to assess the frequency of various discharge diagnoses in AF patients with minor (15–100 ng/L) cardiac high-sensitivity troponin T (TnT) elevations.…”

Section: Introductionmentioning

confidence: 99%

Etiology of Minor Troponin Elevations in Patients with Atrial Fibrillation at Emergency Department–Tropo-AF Study

Jaakkola

Paana

Nuotio

et al. 2019

JCM

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Patients with atrial fibrillation (AF) presenting to the emergency department (ED) often have elevated cardiac troponin T (TnT) levels without evidence of type 1 myocardial infarction. We sought to explore the causes and significance of minor TnT elevations in patients with AF at the ED. All patients with AF admitted to the ED of Turku University Hospital between 1 March, 2013 and 11 April, 2016, and at least two TnT measurements, were screened. Overall, 2911 patients with a maximum TnT of 100 ng/L during hospitalization were analyzed. TnT was between 15 and 100 ng/L in 2116 patients. The most common primary discharge diagnoses in this group were AF (18.1%), infection (18.3%), ischemic stroke/transient ischemic attack (10.7%), and heart failure (5.0%). Acute coronary syndrome (ACS) was equally uncommon both in patients with normal TnT and elevated TnT (4.4% vs. 4.5%). Age ≥75 years, low estimated glomerular filtration rate (eGFR), high C-reactive protein (CRP), and hemoglobin <10.0 g/dL, were the most important predictors of elevated TnT. Importantly, TnT elevation was a very frequent (>93%) finding in elderly (≥75 years) AF patients with either low eGFR or high CRP. In conclusion, minor TnT elevations carry limited diagnostic value in elderly AF patients with comorbidities.

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Cardiac troponin-I as a predictor of mortality in patients with first episode acute atrial fibrillation

Abstract: Elevated cardiac Troponin I is a significant predictor of mortality and a composite endpoint of mortality, stroke or heart failure in patients presenting with first episode acute AF.

Cited by 11 publications

References 17 publications

Migotanie przedsionków z szybką czynnością komór w czasie przełomu tarczycowego

Migotanie przedsionków z szybką czynnością komór w czasie przełomu tarczycowego

Minor troponin T elevation and mortality in patients with atrial fibrillation presenting to the emergency department

Etiology of Minor Troponin Elevations in Patients with Atrial Fibrillation at Emergency Department–Tropo-AF Study

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