High Cardiac Troponin I Is Associated With Transesophageal Echocardiographic Risk of Thromboembolism and Ischemic Stroke Events in Non-Valvular Atrial Fibrillation Patients

Tanaka, Shuhei; Hirai, Tadakazu; Inao, K; Fukuda, Nobuyuki; Nakagawa, Keiko; Inoue, Hiroshi; Kinugawa, Koichiro

doi:10.1253/circj.cj-17-1238

Cited by 6 publications

(6 citation statements)

References 32 publications

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“…We found that markers of cardiac strain and damage like NT-pro BNP and hs troponin T were markedly elevated in patients with LAA thrombi, an observation also reported by previous studies 15 , 16 . Moreover, we could demonstrate a stepwise increase of percentage of patients with LAA thrombi with increasing values of hs troponin T, NT-pro-BNP, fibrinogen and CRP (Fig.…”

Section: Discussionsupporting

confidence: 89%

“…Berg et al 29 showed that troponin T, NT-proBNP, age and history of stroke were the strongest predictors of stroke and systemic embolism. In addition, elevated hs troponin and BNP levels were not only found to be associated with low LAA flow velocities and incidence of LAA thrombus but also linked to worse prognosis in patients with AF 15,16,30 . Addition of a number of these factors to the CHA 2 DS 2 -VASc score could improve prediction of stroke and LAA thrombus formation 7,19 .…”

Section: Discussionmentioning

confidence: 96%

“…To our knowledge, we not only present the largest cohort of patients with LAA thrombi, but also provide a comprehensive assessment of a large number of clinical, echocardiographic and laboratory parameters, some of which previously shown in smaller studies (13-126 patients) to be involved in thrombus formation [3][4][5][6][7][15][16][17][18][19][20][21][22] . In addition, we identified factors associated with LAA thrombus resolution/persistence.…”

Section: Discussionmentioning

confidence: 99%

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Left atrial appendage thrombus formation, potential of resolution and association with prognosis in a large real-world cohort

Hautmann

Zacher

Fuchs

et al. 2023

Sci Rep

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Comprehensive data on factors influencing left atrial appendage (LAA) thrombus formation, resolution and impact on survival are limited. In this single-center, retrospective study 7759 (2010–2015) patients with symptomatic ongoing atrial fibrillation (AF) on admission were screened for LAA thrombi. 450 patients had LAA thrombi. 481 patients without LAA thrombi were randomly selected as controls. We assessed clinical, echocardiographic, laboratory parameters and long-term survival of both groups. Patients with LAA thrombi compared to controls were older, had more strokes, higher CHA2DS2 -VASc scores, worse renal function, less controlled diabetes, advanced heart failure, lower LAA emptying velocities, higher levels of cardiac and inflammatory markers (all p < 0.001). 56.3% of followed-up patients (304) dissolved their LAA thrombi. Chances of thrombus resolution increased with rising LAA flow velocities (OR 1.061, p = 0.022), whereas advanced age (OR 0.950, p < 0.001) and presence of permanent AF (OR 0.354, p < 0.001) decreased chances of thrombus resolution. Presence of LAA thrombi was associated with a markedly reduced 10-year survival probability (31% versus 69%). LAA thrombus formation is promoted by advanced structural heart disease, inflammation, diabetes and impaired renal function. Younger age, non-permanent AF and higher LAA flow velocities were predictors of thrombus resolution. Thrombus formation was associated with poor prognosis.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

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Left atrial appendage thrombus formation, potential of resolution and association with prognosis in a large real-world cohort

Hautmann

Zacher

Fuchs

et al. 2023

Sci Rep

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“…In this analysis, we found that patients with septic shock after restricting volumes of resuscitation fluid strategy with intravenous infusion of UTI showed increased MAP, CO, SV, LVEF, and HR when comparable to those after restricting volumes of resuscitation fluid strategy alone. cTnI, a marker of subclinical myocardial damage, has been reported as a predictor of thromboembolic events in patients with atrial fibrillation [42]. NT-proBNP is a new biomarker of cardiac function and heart failure and has become available as a clinical laboratory test in clinics [43].…”

Section: Discussionmentioning

confidence: 99%

Ulinastatin as an Adjuvant Therapy to Restricting Volumes of Resuscitation Fluid Strategy for Patients with Septic Shock after Initial Management

Dong

Zhang

Zhao

2021

Evidence-Based Complementary and Alternative Medicine

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Septic shock is the most serious complication of sepsis, leading to unacceptably high morbidity and mortality worldwide. Fluid resuscitation using crystalloids has become the mainstay of early and aggressive treatment of severe sepsis and septic shock, while increased daily fluid balances from day 2 until day 7 have been related with increased mortality. Recently, pharmacological management has been recommended to combine with appropriate fluid resuscitation for the treatment of septic shock. In this study, we compared the clinical efficacy of restricting volumes of resuscitation fluid strategy with or without intravenous infusion of ulinastatin (UTI) in treating patients with septic shock and additionally examined the patient’s changes of the extravascular lung water index (EVLWI), pulmonary vascular permeability index (PVPI), systemic vascular resistance index (SVRI), cardiac function, lactic acid (LA) level, coagulation function, and renal function. The study included 182 patients with septic shock, among which 89 patients had undergone restricting volumes of resuscitation fluid strategy with intravenous infusion of UTI and 93 patients had undergone restricting volumes of resuscitation fluid strategy alone. It was found that patients with septic shock after restricting volumes of resuscitation fluid strategy with intravenous infusion of UTI showed an increased SVRI concomitant with declined PVPI and EVLWI, increased mean artery pressure (MAP), cardiac output (CO), left ventricular ejection fraction (LVEF), stroke volume (SV), and heart rate (HR), declined levels of cardiac troponin I (cTnI), N-terminal pro-B-type natriuretic peptide (NT-proBNP), and C-reactive protein (CRP), reduced LA level along with shortened prothrombin time (PT) and partially activated thrombin time (PATT), and decreased levels of blood urea nitrogen (BUN), creatinine (Cr), and uric acid (UA) when comparable to those after restricting volumes of resuscitation fluid strategy alone ( P < 0.05 ). We also observed fewer scores of the Acute Physiology and Chronic Health Evaluation (APACHE II) and the sequential organ failure assessment (SOFA) in patients undergoing restricting volumes of resuscitation fluid strategy with intravenous infusion of UTI than those undergoing restricting volumes of resuscitation fluid strategy alone ( P < 0.05 ). According to the above data, it is concluded that UTI as an adjuvant therapy for restricting volumes of resuscitation fluid strategy in treating septic shock may decrease the LA level, attenuate the inflammatory response, reduce vascular permeability, prevent pulmonary edema, and restore cardiac and renal functions.

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“…As the most widely applied biomarker in cardiovascular disease, emerging evidence suggested that troponin could also predict stroke in patients with AF. In a retrospective study of 199 NVAF patients, elevated hs-cTnI was independently associated with abnormal anatomy of the LA, defined as LAA flow velocity <20 cm/s or dense spontaneous echo contrast, and the incidence of IS increases with higher cTnI levels ( 119 ). Similar to NT-proBNP, the post-hoc analyses of ARISTOTLE trial ( 120 ), RE-LY trial ( 111 ), and ENGAGE AF-TIMI 48 trial ( 112 ) also indicated a positive association between cTnI/cTnT level and risk of TE/IS, and integrating troponin to the CHA 2 DS 2 -VASc score could improve C-statistics.…”

Section: Circulating Biomarkersmentioning

confidence: 99%

A Review of Biomarkers for Ischemic Stroke Evaluation in Patients With Non-valvular Atrial Fibrillation

Shang

Zhang

Guo

et al. 2021

Front. Cardiovasc. Med.

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Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia worldwide and results in a significantly increased ischemic stroke (IS) risk. IS risk stratification tools are widely being applied to guide anticoagulation treatment decisions and duration in patients with non-valvular AF (NVAF). The CHA2DS2-VASc score is largely validated and currently recommended by renowned guidelines. However, this score is heavily dependent on age, sex, and comorbidities, and exhibits only moderate predictive power. Finding effective and validated clinical biomarkers to assist in personalized IS risk evaluation has become one of the promising directions in the prevention and treatment of NVAF. A number of studies in recent years have explored differentially expressed biomarkers in NVAF patients with and without IS, and the potential role of various biomarkers for prediction or early diagnosis of IS in patients with NVAF. In this review, we describe the clinical application and utility of AF characteristics, cardiac imaging and electrocardiogram markers, arterial stiffness and atherosclerosis-related markers, circulating biomarkers, and novel genetic markers in IS diagnosis and management of patients with NVAF. We conclude that at present, there is no consensus understanding of a desirable biomarker for IS risk stratification in NVAF, and enrolling these biomarkers into extant models also remains challenging. Further prospective cohorts and trials are needed to integrate various clinical risk factors and biomarkers to optimize IS prediction in patients with NVAF. However, we believe that the growing insight into molecular mechanisms and in-depth understanding of existing and emerging biomarkers may further improve the IS risk identification and guide anticoagulation therapy in patients with NVAF.

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High Cardiac Troponin I Is Associated With Transesophageal Echocardiographic Risk of Thromboembolism and Ischemic Stroke Events in Non-Valvular Atrial Fibrillation Patients

Cited by 6 publications

References 32 publications

Left atrial appendage thrombus formation, potential of resolution and association with prognosis in a large real-world cohort

Left atrial appendage thrombus formation, potential of resolution and association with prognosis in a large real-world cohort

Ulinastatin as an Adjuvant Therapy to Restricting Volumes of Resuscitation Fluid Strategy for Patients with Septic Shock after Initial Management

A Review of Biomarkers for Ischemic Stroke Evaluation in Patients With Non-valvular Atrial Fibrillation

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