AI Article Synopsis
- - The study investigates the relationship between high-sensitivity cardiac troponin T (hs-cTnT) levels and structural heart abnormalities in patients with atrial fibrillation/flutter, as elevated hs-cTnT is associated with a poorer prognosis.
- - Out of 401 patients without definite causes for increased hs-cTnT, 84% showed elevated levels, with the majority experiencing nonischemic myocardial injury, and those with myocardial injury had more significant cardiac issues like increased left ventricular mass and higher mortality rates.
- - Identifying the underlying causes of myocardial injury in these patients is crucial for developing tailored treatment strategies and improving outcomes.
Article Abstract
Background: High-sensitivity cardiac troponin (hs-cTnT) is often increased in patients with atrial fibrillation/flutter, portending a poor prognosis. The etiologies for these increases have not been systematically investigated. Our aim was to define prevalence/significance of structural cardiac abnormalities in patients with atrial fibrillation/flutter and high-sensitivity cardiac troponin T (hs-cTnT) increases.
Methods: This is a retrospective observational cohort study of patients with atrial fibrillation/flutter diagnosis with hs-cTnT measurements, echocardiograms, and coronary angiograms. Myocardial injury was defined as hs-cTnT >10 ng/L for women and >15 ng/L for men. Cases with myocardial injury were adjudicated according to the Fourth Universal Definition of Myocardial Infarction.
Results: Patients with definite causes for increased hs-cTnT (n = 875) were tabulated but not evaluated further; common diagnoses were type 1 myocardial infarction, critical illness, and known heart failure. Of the remaining 401, increased hs-cTnT was present in 336 (84%) patients. Of those, 78% had nonischemic myocardial injury, the remaining (n = 75, 22%) had type 2 myocardial infarction. Patients with elevated hs-cTnT had greater left ventricular mass index, left ventricular filling pressures, and right ventricular systolic pressure. They more frequently had significant coronary artery disease (47% vs 31%, P = .016), especially in type 2 myocardial infarction. With logistic regression, age, sex (F), diabetes, left ventricular mass index, e' medial velocity, and right ventricular systolic pressure were independent determinants of myocardial injury. One-year mortality was higher in patients with myocardial injury.
Conclusions: Structural heart abnormalities are common in patients with atrial fibrillation/flutter and increased hs-cTnT. Causes of myocardial injury should be elucidated in each patient to craft appropriate therapies.
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| http://dx.doi.org/10.1016/j.amjmed.2022.06.005 | DOI Listing |
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