Minor elevations in troponin I are associated with mortality and adverse cardiac events in patients with atrial fibrillation

Bos, Ewout J. van den; Constantinescu, Alina A.; Domburg, Ron T. van; Akın, Şakir; Jordaens, Luc; Kofflard, Marcel

doi:10.1093/eurheartj/ehq491

Cited by 95 publications

(68 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Recently, cardiac troponins have been known to be associated with incident AF in the general population,26 and are associated with delayed diagnosis of AF after stroke 27. However, it is still unclear whether the pathomechanism of troponin elevation in AF is due to AF itself (eg, accompanying tachycardia with a fast ventricular response) or due to pre‐existing heart failure with or without LAE 28. Thus, our results could suggest that structural heart problems may play an important role in the identification of newly detected AF in stroke patients.…”

Section: Discussionmentioning

confidence: 99%

Cardiac Vulnerability to Cerebrogenic Stress as a Possible Cause of Troponin Elevation in Stroke

Ahn

Kim

Shin

et al. 2016

JAHA

View full text Add to dashboard Cite

BackgroundTroponin elevation with electrocardiography changes is not uncommon in patients with acute ischemic stroke; however, it is still unclear whether the mechanism of these changes is due to cardiac problems or neurally mediated myocytic damage. Thus, we investigated cardiac and neurological predictors of troponin elevation in those patients.Methods and ResultsWe retrospectively analyzed medical data of the prospectively registered ischemic stroke patients on stroke registry who were admitted and underwent a serum cardiac troponin I and 12‐lead electrocardiography within 24 hours of symptom onset. However, patients with well‐known troponin‐elevating comorbidities were excluded from the analysis. Among 1404 ischemic stroke patients, 121 (8.7%) had elevated troponin, which was defined as more than 0.04 mg/mL. Multivariable analysis identified electrocardiography abnormalities such as QTc‐prolongation (odds ratio [OR]: 1.52, 95% CI: 1.02–2.28), left ventricular hypertrophy (OR: 2.14, 95% CI 1.43–3.19), Q‐wave (OR: 2.53, 95% CI: 1.48–4.32), and ST elevation (OR: 2.74, 95% CI: 1.12–6.72) as cardiac variables associated with troponin elevation, and higher National Institutes of Health Stroke Scale score (OR: 1.04, 95% CI: 1.01–1.07) and insular cortical lesions (OR: 2.78, 95% CI: 1.85–4.19) as neurological variables associated with troponin elevation. Incidence of troponin elevation as well as QTc‐prolongation was increased further in combination with cardiac and neurological factors.ConclusionsCertain cardiac and neurological conditions in acute ischemic stroke may contribute to troponin elevation. The proposed concept of cardiac vulnerability to cerebrogenic stress can be a practical interpretation of troponin elevation and electrocardiography abnormalities in stroke patients.

show abstract

Section: Discussionmentioning

confidence: 99%

Cardiac Vulnerability to Cerebrogenic Stress as a Possible Cause of Troponin Elevation in Stroke

Ahn

Kim

Shin

et al. 2016

JAHA

View full text Add to dashboard Cite

show abstract

“…Cumulative 3-year survival rates were 78% in the non-detectable troponin I group, 62% in the minor elevation group, and 57% in the positive troponin I group (log-rank P < 0.001). [23] A sub-study of the Randomized Evaluation of Long-Term Anticoagulant Therapy trial (RE-LY), performed in 6189 patients with AF and treated with either warfarin or dabigatran, found that cTnI was predictive of thromboembolic events and cardiovascular mortality, and even after adjustment by potential confounding factors, the risk of stroke or systemic embolism was doubled to fivefold higher for cardiovascular mortality, in patients with the highest quartiles. Hijazi et al demonstrated that persistent elevation of troponin I was seen in nearly half of the patients in the RE-LY study cohort comprising of patients with anticoagulated AF with ≥1 risk factor for stroke.…”

Section: Prognostic Value Of Elevated Troponin Levelsmentioning

confidence: 99%

The Significance Of Troponin Elevation In Atrial Fibrillation

Costabel

Burgos

Trivi

2017

Journal of Atrial Fibrillation

View full text Add to dashboard Cite

“…Some investigators believe that increased wall stress, demand-supply mismatch, or angiotensin 2-induced oxidative stress are possible explanations for troponin elevations in selected AF patients. 46 …”

Section: Troponinmentioning

confidence: 99%

“…Because these studies used different assays, an absolute number for troponin elevation cannot be established to guide clinical decision making, such as that available for myocardial infarction. [45][46][47][48] In another study, patients with elevated levels of hstroponin T were 2.2 times more likely to have adverse cardiovascular events and were at 1.8-fold increased risk for all-cause mortality compared with patients with normal hs-TnT, even after adjusting for CHADS 2 score. 49 These results were derived from real-world AF patients who are receiving chronic (.6 months) stable anticoagulation with warfarin (time in therapeutic range, .70%) and are complementary to the previously discussed results of the RE-LY and ARISTOTLE clinical trials.…”

Section: Singla Et Almentioning

confidence: 99%

Who will benefit from anticoagulant therapy? Use of the CHADS2 score and its variants

Singla¹,

Mittal²,

Flaker³

2014

RRCC

View full text Add to dashboard Cite

Stroke prevention is a crucial step in the management of atrial fibrillation (AF). The assessment of stroke risk associated with AF varies, depending on the presence of various clinical risk factors (older age, congestive heart failure, diabetes mellitus, hypertension, history of stroke or transient ischemic attack, female sex, or peripheral vascular disease) incorporated in risk stratification models such as CHADS 2 and CHA 2 DS 2 -VASc. Although these models have modest predictive ability in individual patients, current guidelines advocate the use of a CHA 2 DS 2 -VASc risk score to identify very low risk patients who can avoid antithrombotic therapy, as well as all others who can benefit from such therapy. More recently biomarkers and imaging has improved our knowledge of pathophysiology of AF and may further improve risk stratification for thromboprophylaxis in AF patients. These new markers combined with clinical risk scores may enable the development of novel tools to improve clinical risk assessment in AF. In this article, we summarize the recent developments in risk stratification for stroke prevention in AF, including the various schemes and new biomarkers that may lead to improved patient outcomes.

show abstract

Minor elevations in troponin I are associated with mortality and adverse cardiac events in patients with atrial fibrillation

Abstract: Minor elevations in troponin I on hospital admission are associated with mortality and cardiac events in patients with atrial fibrillation and might be useful for risk stratification.

Cited by 95 publications

References 26 publications

Cardiac Vulnerability to Cerebrogenic Stress as a Possible Cause of Troponin Elevation in Stroke

Cardiac Vulnerability to Cerebrogenic Stress as a Possible Cause of Troponin Elevation in Stroke

The Significance Of Troponin Elevation In Atrial Fibrillation

Who will benefit from anticoagulant therapy? Use of the CHADS2 score and its variants

Contact Info

Product

Resources

About