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

Results

Baseline Patient Characteristics

The comparison of baseline patient characteristics among the three groups according to the hs-TnT levels is shown in Table 1. The median hs-TnT level was 0.008 μg/L (interquartile range, 0.003-0.087 μg/L). Patients in the high hs-TnT group were more likely to be older; had the highest prevalence of hypertension and estimated glomerular filtration rate (eGFR) lesser than 60 mL·min−1·1.73 m−2; and had the highest CHA2DS2-VASc score, high-sensitive C-reactive protein (hs-CRP) level, B-type natriuretic peptide (BNP) level, LAD, and E/e′ ratio among the three groups. There were no significant differences in the other variables among the three groups. At the last follow-up, the rate of antiarrhythmic drug use was 10% (n = 22) and that of oral anticoagulant use was 55% (n = 125) (warfarin: n = 26 and DOACs: n = 99).

Atrial Fibrillation Recurrence

During a mean follow-up of 15 ± 8 months, AF recurred in 56 (25%) patients (low hs-TnT group, n = 10 [19%]; medium hs-TnT group, n = 28 [22%]; and high hs-TnT group, n = 18 [39%]). The prevalence of persistent AF was significantly higher in patients with AF recurrence than in those without (Table 2). The prevalence of hs-TnT greater than or equal to 0.014 μg/L tended to be higher in patients with AF recurrence than in those without, although the statistical analysis did not show significance. The Kaplan-Meier curves of the incidence of freedom from AF recurrence are shown in Figure 1. The incidence of freedom from AF recurrence tended to be the lowest in patients with hs-TnT greater than or equal to 0.014 μg/L among the three groups.

Figure 1.

Kaplan-Meier Curve of freedom from AF recurrence after the ablation among the 3 groups according to hs-TnT levels. The incidence of freedom from AF recurrence tended to be the lowest in patients with hs-TnT greater than or equal to 0.014 μg/L among the three groups

Major Adverse Cardiovascular Events

MACE occurred in nine (4%) patients at a median follow-up of 531 days (92-1338 days) after AF ablation. The detailed profile of patients with MACE is shown in Table 3. Stroke, acute coronary syndrome, and heart failure hospitalization occurred in two, one, and seven patients, respectively. MACE was associated with hs-TnT greater than or equal to 0.014 μg/L, previous ischemic heart disease and stroke, eGFR lesser than 60 mL·min−1·1.73 m−2, high CHA2DS2-VASc score, and decreased LVEF (Table 4). Patients with both hs-TnT greater than or equal to 0.014 μg/L and eGFR lesser than 60 mL·min−1·1.73 m−2 had the highest incidence of MACE than the others (18% vs 2%, P < .01), and those with both hs-TnT greater than or equal to 0.014 μg/L and previous ischemic heart disease the highest incidence of MACE than the others (50% vs 3%, P < .01). The hs-TnT greater than or equal to 0.014 μg/L was an independent risk factor of MACE after an adjustment for the presence of eGFR lesser than 60 mL·min−1·1.73 m−2 (HR 6.98; CI, 1.46-51.0; P = .03) or previous ischemic heart disease (HR, 7.84; CI, 1.76-54.6; P = .01).

The Kaplan-Meier curves of the incidence of freedom from the composite end point (AF recurrence or MACE) are shown in Figure 2. Patients with hs-TnT ≥0.014 μg/L had the lowest incidence of freedom from the composite end point among the three groups (log-rank P < 0.05).

Figure 2.

Kaplan-Meier Curve of freedom from composite endpoint including AF recurrence or major adverse cardiovascular events after the ablation among the three groups according to hs-TnT levels. The incidence of freedom from the composite endpoint was the lowest in patients with hs-TnT greater than or equal to 0.014 μg/L among the three groups. AF, atrial fibrillation; hs-TnT, high-sensitive troponin T

Univariate and Multivariate Analyses of the Composite Endpoint After Atrial Fibrillation Ablation

We performed univariate and multivariate analyses to investigate whether the variables were associated with the incidence of the composite endpoint (Table 5). In the univariate analysis, the composite endpoint after AF ablation was associated with hs-TnT greater than or equal to 0.014 μg/L, CHA2DS2-VASc score, and persistent AF. In a multivariate analysis, hs-TnT greater than or equal to 0.014 μg/L and persistent AF were independent predictors of the composite endpoint after AF ablation.

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