Dynamic high-sensitivity troponin elevations in atrial fibrillation patients might not be associated with significant coronary artery disease

Abstract

BackgroundSince the introduction of high-sensitivity troponin assays a greater proportion of atrial fibrillation (AF) patients present with dynamic troponin elevations. We hypothesize that significant coronary artery disease (CAD) causes relative ischemia in the setting of a rapid heart rate resulting in dynamic troponin elevation. The aim of this study was to examine if patients without known CAD who present with AF, tachycardia and dynamic high-sensitivity troponin T (hsTnT) change have an increased risk of cardiac events.MethodsWe retrospectively included AF patients presenting with tachycardia during one year. The primary endpoint was acute coronary syndrome, revascularization or death due to ischemic heart disease during 30 months follow-up.ResultsFive hundred twenty-two patients without known CAD were included, 300 (57%) had normal hsTnT and 49 (9.5%) had dynamic hsTnT elevation. During follow-up 12 (4%) patients with normal hsTnT reached the primary endpoint and a total of 14 (4.7%) patients died. In the group with dynamic hsTnT the results were 4 (8.2%) and 12 (25%) respectively. The age-adjusted hazard ratio (HR) for the primary endpoint in patients with dynamic hsTnT was 1.9 (95% CI: 0.6 to 6.2; p = 0.28) and for all-cause mortality 3.8 (95% CI: 1.7 to 8.5; p = 0.001).ConclusionsDynamic hsTnT elevation in connection with AF might not be associated with any major increased risk of coronary events, but indicates increased all-cause mortality.Electronic supplementary materialThe online version of this article (doi:10.1186/s12872-017-0601-7) contains supplementary material, which is available to authorized users.

Low risk patients with acute atrial fibrillation and elevated high-sensitivity troponin do not have increased incidence of pathological stress test: a prospective cohort study

“…In this study we try to look at a specific clinical issue in a pragmatic way. We have also tried to address the same question in a previous retrospective study, where we could not find any strong correlation between dynamic hsTnT elevations in AF/AFL patients and significant CAD during follow-up [36], which is in line with the finding in this study. However, dynamic hsTnT elevations were associated with increased allcause mortality, signalling presence of some kind of unknown pathophysiology [36].…”

“…We have also tried to address the same question in a previous retrospective study, where we could not find any strong correlation between dynamic hsTnT elevations in AF/AFL patients and significant CAD during follow-up [36], which is in line with the finding in this study. However, dynamic hsTnT elevations were associated with increased allcause mortality, signalling presence of some kind of unknown pathophysiology [36]. Even if we acknowledge the fact that both the present and our previous study have methodological shortcomings, are relatively small and are underpowered to detect minor significant differences.…”

Biomarkers of Atrial Fibrillation: Which One Is a True Marker?

“…This elevation did not have a strong association with significant epicardial coronary artery disease suggested by several studies. Tachycardia could be the point of ischemic stress in this clinical setting as researchers found on multivariate analysis [28–30]. This finding suggests that troponin elevation alone cannot be directly considered as myocardial infarction even though the troponin level increased above 99th percentile as the guideline recommendation.…”

Myocardial Injury in the Era of High-Sensitivity Cardiac Troponin Assays

“…Cardiovascular causes of acute myocardial injury include MI, 8 pulmonary embolism (PE), 25 myocarditis, 17 and/or myopericarditis, 26 aortic dissection, 27 cardiac surgery, 28 or procedures 29 (e.g. cardioversion or ablation), hypertension, 16 arrhythmias, 30 acute HF, 31 acute valvular heart disease 32 (e.g. : aortic regurgitation or mitral regurgitation), Takotsubo cardiomyopathy, 33 and cardiac contusions 34 (including chest compressions).…”