Troponin utilization in patients presenting with atrial fibrillation/flutter to the emergency department: retrospective chart review

Meshkat, Nazanin; Austin, Emily; Moineddin, Rahim; Hatamabadi, Hamidreza; Hassani, B.; Abdalvand, Ali; Marcuzzi, Amanda

doi:10.1186/1865-1380-4-25

Cited by 16 publications

(8 citation statements)

References 14 publications

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“…Another study, by Meshkat et al, reported the incidence of troponin testing in patients presenting to the ED with AF to be 86%. However, that study included all patients with positive troponins, including those with MI and ACS, and did evaluate the prognostic significance of troponin elevation …”

Section: Discussionmentioning

confidence: 99%

“…However, that study included all patients with positive troponins, including those with MI and ACS, and did evaluate the prognostic significance of troponin elevation. 24 Another unique finding of this current study is that we looked at the group of patients who did not have any troponins measured despite presenting with AF (group 3). The study found that this group had similar MI and mortality rates as the group with negative troponins.…”

Section: Troponin Elevation and Atrial Fibrillationmentioning

confidence: 99%

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Clinical Utility and Prognostic Significance of Measuring Troponin I Levels in Patients Presenting to the Emergency Room With Atrial Fibrillation

Gupta

Pillarisetti

Biria

et al. 2014

Clinical Cardiology

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Background:The clinical significance of mildly elevated troponins in patients presenting to the emergency room (ER) with atrial fibrillation (AF) is not well understood. Hypothesis: We hypothesized that mildly elevated troponin in these patients is associated with adverse cardiovascular outcomes. Methods: In a multi-center, retrospective study, 662 patients with AF were divided into 3 groups based on troponin levels: group 1, mildly elevated; group 2, normal; and group 3, troponin not measured. Primary outcome was the combined endpoint of all-cause mortality and myocardial infarction (MI) at one year. Results: Levels of TnI were measured in 503 (76%) patients. They were elevated in 220 patients (33%, group 1; mean, 0.56 ng/mL), normal in 283 patients (43%, group 2), and not measured in 159 patients (24%, group 3). Significantly more cardiac testing was done at index hospitalization in group 1 (50%) compared with groups 2 and 3 (28% and 29%, P ≤ 0.001) and in the following year (29%, vs 20% and 17%, P = 0.02). Group 1 had more positive tests (62%) compared with groups 2 and 3 (25% and 43%, P ≤ 0.001). Group 1 had a significantly higher occurrence of the primary endpoint (22%, vs 10% and 15%, P = 0.002), driven primarily by a higher incidence of MI in group 1 (7%, vs 1% and 2%, P = 0.001). Conclusions: Troponin levels are routinely checked in a majority of patients presenting to the emergency department with AF. Even mildly elevated TnI is associated with a greater incidence of coronary artery disease on diagnostic testing and a higher 1-year incidence of MI.

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Section: Discussionmentioning

confidence: 99%

Section: Troponin Elevation and Atrial Fibrillationmentioning

confidence: 99%

Clinical Utility and Prognostic Significance of Measuring Troponin I Levels in Patients Presenting to the Emergency Room With Atrial Fibrillation

Gupta

Pillarisetti

Biria

et al. 2014

Clinical Cardiology

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“…Recent evidence has shown that in some ED's, troponin utilization may be as high as 86% in patients with atrial fibrillation and only 4.9% are treated for acute coronary syndrome [23].…”

Section: Limitationsmentioning

confidence: 99%

Cardioversion safety in patients with nonvalvular atrial fibrillation

Providência

Faustino²,

Paiva³

et al. 2012

Blood Coagulation &Amp; Fibrinolysis

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The objective of this study was to derive and test a score that can accurately predict the presence of left atrial or left atrial appendage thrombus (LAAT) in order to identify patients with nonvalvular atrial fibrillation who can be spared transesophageal echocardiogram (TEE) and safely cardioverted. This cross-sectional observational study including 180 individuals (37.2% women) undergoing clinical, echocardiographic and laboratory evaluation (including cardiac troponin I and C reactive protein; CRP) during an atrial fibrillation episode. LAAT was sought on TEE and predictors of this transesophageal echocardiographic finding were assessed. Based on predictors of LAAT (CRP, atrial volume, troponin, episode duration and stroke or embolism) we derived the CATES score and tested its accuracy through receiver operating curve analysis. LAAT was found in 9.4%. CHADS2 and CHA2DS2-VASc had a modest performance in predicting these changes displaying a 0.620 (c-statistic) in average. Using CATES score displayed a higher area under the curve value 0.816 for LAAT. No patients with LAAT were observed in patients with CATES scores ranging from '0' to '2', which corresponded to 49.4% (n = 89) of the sample. We developed a score that presented a very good accuracy for the detection of LAAT in our sample. Further studies in other populations, such as with bigger dimensions, are needed to validate this score and confirm its capability of selecting a very low risk group of patients that can be spared transesophageal echocardiography.

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“…Atrial fibrillation (AF) is the most common arrhythmia in the general population, and due to changing demographics, the number of patients with AF is continuously increasing [ 9 , 10 ]. A large proportion of AF patients will be hospitalized during their lifetime and many of these patients will be admitted to emergency departments for cardiac troponin testing [ 11 , 12 ]. Different mechanisms have been proposed to lead to troponin elevation in individuals with AF [ 13 – 15 ].…”

Section: Introductionmentioning

confidence: 99%

Identification of acute myocardial infarction in patients with atrial fibrillation and chest pain with a contemporary sensitive troponin I assay

Liebetrau

Weber

Tzikas

et al. 2015

BMC Med

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BackgroundThe introduction of modern troponin assays has facilitated diagnosis of acute myocardial infarction due to improved sensitivity with corresponding loss of specificity. Atrial fibrillation (AF) is associated with elevated levels of troponin. The aim of the present study was to evaluate the diagnostic performance of troponin I in patients with suspected acute coronary syndrome and chronic AF.MethodsContemporary sensitive troponin I was assayed in a derivation cohort of 90 patients with suspected acute coronary syndrome and chronic AF to establish diagnostic cut-offs. These thresholds were validated in an independent cohort of 314 patients with suspected myocardial infarction and AF upon presentation. Additionally, changes in troponin I concentration within 3 hours were used.ResultsIn the derivation cohort, optimized thresholds with respect to a rule-out strategy with high sensitivity and a rule-in strategy with high specificity were established. In the validation cohort, application of the rule-out cut-off led to a negative predictive value of 97 %. The rule-in cut-off was associated with a positive predictive value of 88 % compared with 71 % if using the 99th percentile cut-off. In patients with troponin I levels above the specificity-optimized threshold, additional use of the 3-hour change in absolute/relative concentration resulted in a further improved positive predictive value of 96 %/100 %.ConclusionsTroponin I concentration and the 3-hour change in its concentration provide valid diagnostic information in patients with suspected myocardial infarction and chronic AF. With regard to AF-associated elevation of troponin levels, application of diagnostic cut-offs other than the 99th percentile might be beneficial.Electronic supplementary materialThe online version of this article (doi:10.1186/s12916-015-0410-8) contains supplementary material, which is available to authorized users.

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Troponin utilization in patients presenting with atrial fibrillation/flutter to the emergency department: retrospective chart review

Cited by 16 publications

References 14 publications

Clinical Utility and Prognostic Significance of Measuring Troponin I Levels in Patients Presenting to the Emergency Room With Atrial Fibrillation

Clinical Utility and Prognostic Significance of Measuring Troponin I Levels in Patients Presenting to the Emergency Room With Atrial Fibrillation

Cardioversion safety in patients with nonvalvular atrial fibrillation

Identification of acute myocardial infarction in patients with atrial fibrillation and chest pain with a contemporary sensitive troponin I assay

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