Prognostic Value of High-sensitive Troponin T for Predicting Cardiovascular Events After Atrial Fibrillation Ablation

Shota Tamura MD; Atsushi Doi MD, PhD; Masanori Matsuo MD; Hisashi Katayama MD; Tomotaka Yoshiyama MD; Hiroaki Tatsumi MD, PhD; Yasuhiro Izumiya MD, PhD; Minoru Yoshiyama MD, PhD

Disclosures

J Cardiovasc Electrophysiol. 2019;30(9):1475-1482. 

In This Article

Abstract and Introduction

Abstract

Background and Objectives: This study aimed to evaluate the utility of high-sensitive troponin T (hs-TnT) for predicting AF recurrence and major adverse cardiovascular events (MACE) after AF ablation.

Methods and Results: A total of 227 consecutive patients with AF (mean age, 66 ± 10 years; persistent AF, n = 98) who underwent an initial ablation were enrolled. We measured hs-TnT before AF ablation and divided the patients into three groups according to the hs-TnT level: low, lesser than or equal to 0.005 μg/L (n = 54); medium, 0.006–0.013 μg/L (n = 127); and high, greater than or equal to0.014 μg/L (n = 46). We evaluated the composite endpoint of AF recurrence or MACE (including death, stroke, acute coronary syndrome, and heart failure hospitalization) after the ablation. The median hs-TnT level was 0.008 μg/L. The values of chronic kidney disease prevalence, CHA2DS2-VASc score, B-type natriuretic peptide level, and left atrial diameter were the highest in the high hs-TnT group among the three groups. During a mean follow-up of 15 ± 8 months, AF recurrence and MACE occurred in 56 (25%) and 9 (4%) patients, respectively. The high hs-TnT group had the highest incidence of AF recurrence and MACE among the three groups (high: 39% and 15%, medium: 22% and 2%, and low: 19% and 0%, respectively; log-rank P < .05). In multivariate analysis, hs-TnT greater than or equal to 0.014 μg/L and persistent AF were independent predictors of the composite endpoint.

Conclusion: Hs-TnT may be a useful marker for predicting AF recurrence or MACE after AF ablation.

Introduction

Atrial fibrillation (AF) is a common cardiac arrhythmia and is associated with increased mortality and morbidity.[1,2] Some clinical studies have reported that catheter ablation reduces AF recurrence and improves the quality of life better than antiarrhythmic drugs.[3,4] In recent propensity score-matched population-based studies, the incidence of stroke and mortality was significantly lower in the ablation group than in the nonablation group.[5,6] However, risk stratification tools are needed in the decision making about oral coagulants and medical treatments for individual patients after AF ablation. Previous studies reported that the CHA2DS2-VASc score was useful in identifying patients with AF at a high risk of stroke, myocardial infarction, and cardiac mortality.[7–9] Moreover, the CHA2DS2-VASc score was also reported to be an excellent tool in stratifying patients in terms of clinical outcomes such as AF recurrence, stroke, heart failure, and death after AF ablation.[10]

High-sensitive troponin T (hs-TnT) is a biochemical marker of myocardial damage. The ARISTOTLE Investigators reported that an elevated hs-TnT level was independently associated with an increased risk of stroke, cardiac death, and major bleeding in patients with AF and that hs-TnT improved the risk stratification beyond the CHA2DS2-VASc score.[11] However, the prognostic value of hs-TnT after AF ablation was unknown. The purpose of this study was to evaluate the utility of hs-TnT for predicting AF recurrence and major adverse cardiovascular events (MACE) after AF ablation.

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