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.

Conclusion

Beyond the CHA₂DS₂-VASc score, the hs-TnT level may be a useful marker for predicting AF recurrence or MACE after CF-RFCA and CBA.

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Table 1. Comparison of clinical characteristics among the three groups according to hs-TnT levels
	Total (N = 227)	hs-TnT (μg/L)			P value
	Total (N = 227)	Low: ≤ 0.005 (N = 54)	Medium: 0.006-0.013 (N = 127)	High: ≥ 0.014 (N = 46)	P value
Age, y	66 ± 10	56 ± 11	68 ± 7	71 ± 8	.0001
Male, n (%)	156 (69)	39 (72)	87 (69)	30 (65)	.75
Persistent AF, n (%)	98 (43)	25 (46)	53 (42)	20 (43)	.87
Hypertension, n (%)	137 (60)	23 (43)	77 (61)	37 (80)	.0006
Ischemic heart disease, n (%)	13 (6)	2 (4)	5 (4)	6 (13)	.057
Previous stroke, n (%)	15 (7)	1 (2)	9 (7)	5 (11)	.18
CHA₂DS₂-VASc score	2.5 ± 1.6	1.4 ± 1.3	2.5 ± 1.4	3.6 ± 1.7	.0001
BNP, pg/dL	102 ± 132	65 ± 65	86 ± 82	191 ± 231	.0001
hs-CRP, mg/dL	0.11 ± 0.17	0.08 ± 0.08	0.12 ± 0.16	0.15 ± 0.24	.024
eGFR, <60 mL·min⁻¹·1.73 m⁻², n (%)	46 (20)	3 (6)	21 (17)	22 (48)	.0001
LAD, mm	41 ± 6	39 ± 7	40 ± 6	45 ± 6	.001
E/e′	11.9 ± 4.6	9.9 ± 3.8	11.6 ± 3.5	15.2 ± 6.2	.0001
LVEF, %	57 ± 8	56 ± 10	57 ± 7	56 ± 9	.93
Cryoballoon ablation, n (%)	50 (22)	9 (17)	32 (25)	9 (20)	.40
Antiarrhythmic drugs, n (%)	78 (34)	23 (43)	45 (35)	10 (22)	.09
ACE-I/ARB, n (%)	88 (39)	18 (33)	45 (35)	25 (54)	.051
β-Blocker, n (%)	84 (37)	25 (46)	39 (31)	20 (43)	.08
Statin, n (%)	47 (21)	4 (7)	27 (21)	16 (35)	.003
DOAC, n (%)	195 (86)	52 (96)	108 (85)	35 (76)	.01
Follow-up periods, mo	15.7 ± 8.2	15.5 ± 8.5	16.0 ± 7.9	15.2 ± 8.8	.65

Abbreviations: ACE-I/ARB, angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker; AF, atrial fibrillation; BNP, B-type natriuretic peptide; DOAC, direct oral anticoagulants; eGFR, estimated glomerular filtration rate; hs-CRP, high-sensitive C-reactive protein; hs-TnT, high-sensitive troponin T; LAD, left atrial diameter; LVEF, left ventricular ejection fraction.

Table 2. Univariate analysis of the predictors of AF recurrence after ablation
	Recurrence		Univariate analysis
	+ (N = 56)	− (N = 171)	HR	95% CI	P value
Age, y	66 ± 8	65 ± 11	1.00	0.98-1.03	.83
Male, n (%)	34 (61)	122 (71)	0.65	0.38-1.12	.12
Persistent AF, n (%)	33 (59)	65 (43)	1.87	1.10-3.24	.021
Hypertension, n (%)	31 (55)	106 (62)	0.90	0.53-1.55	.70
CHA₂DS₂-VASc score	2.8 ± 1.7	2.4 ± 1.5	2.40	0.66-8.63	.18
hs-CRP, mg/dL	0.12 ± 0.16	0.11 ± 0.17	1.41	0.13-7.21	.73
hs-TnT, ≥0.014 μg/L	18 (32)	28 (16)	1.78	0.99-3.08	.054
BNP, pg/dL	124 ± 130	95 ± 132	2.24	0.22-11.8	.42
eGFR<60 mL·min⁻¹·1.73 m⁻², n (%)	11 (20)	35 (20)	0.88	0.43-1.65	.71
LAD >40 mm, n (%)	34 (61)	82 (48)	1.35	0.79-2.34	.27
E/e′ >14, n (%)	14 (25)	33 (19)	1.34	0.71-2.40	.35
LVEF, %	56 ± 9	57 ± 8	1.00	0.97-1.03	.23
Cryoballoon ablation, n (%)	8 (14)	42 (25)	0.65	0.28-1.30	.23
ACE-I/ARB, n (%)	18 (32)	70 (41)	0.65	0.36-1.12	.12
β-Blocker, n (%)	21 (38)	63 (37)	0.95	0.54-1.61	.84
DOAC, n (%)	46 (82)	149 (87)	0.80	0.42-1.67	.52
Statin, n (%)	10 (18)	37 (22)	0.79	0.38-1.51	.50
Antiarrhythmic drugs, n (%)	16 (29)	62 (36)	0.65	0.35-1.14	.14

Abbreviations: ACE-I/ARB, angiotensin-coverting enzyme inhibitor/angiotensin II receptor blocker; AF, atrial fibrillation; BNP, B-type natriuretic peptide; CI, confidence interval; DOAC, direct oral anticoagulants; eGFR, estimated glomerular filtration rate; HR, hazard ration; hs-CRP, high-sensitive C-reactive protein; hs-TnT, high-sensitive troponin T; LAD, left atrial diameter; LVEF, left ventricular ejection fraction.

Table 3. Major adverse cardiovascular events after atrial fibrillation ablation
	hs-TnT (μg/L)			P value	AF recurrence		P value
	≤0.005 (N = 54)	0.006-0.013 (N = 127)	≥0.014 (N = 46)	P value	+ (N = 56)	− (N = 171)	P value
Major adverse cardiovascular events, n (%)	0	2 (1.6)	7 (15)	.0001	4 (7.1)	5 (2.9)	.16
Death	0	0	0	–	0	0	–
Stroke, n (%)	0	1 (0.8)	1 (2.2)	.50	0	2 (1.2)	.42
Acute coronary syndrome, n (%)	0	1 (0.8)	0	.67	1 (1.8)	0	.09
Heart failure, n (%)	0	1 (0.8)	6 (13)	.0001	4 (7.1)	3 (1.8)	.04

Abbreviations: AF, atrial fibrillation; hs-TnT, high-sensitive troponin T.

Table 4. Univariate analysis of the predictors of major adverse cardiovascular events after ablation
	+ (N = 9)	− (N = 218)	Univariate analysis
	+ (N = 9)	− (N = 218)	HR	95% CI	P value
Age, y	71 ± 6	65 ± 10	1.06	0.99-1.16	.13
Male, n (%)	5 (56)	151 (69)	0.61	0.16-2.48	.47
Persistent AF, n (%)	6 (67)	92 (42)	2.29	0.60-11.0	.23
Ischemic heart disease, n (%)	4 (44)	9 (4)	18.30	4.32-77.6	.0003
Previous stroke, n (%)	3 (33)	12 (6)	5.19	1.06-20.2	.04
CHA₂DS₂-VASc score	4.6 ± 1.8	2.4 ± 1.5	1.73	1.22-2.45	.002
hs-CRP, mg/dL	0.19 ± 0.21	0.11 ± 0.17	12.34	0.08-188.3	.16
hs-TnT ≥0.014 μg/L, n(%)	7 (78)	39 (18)	11.83	2.83-79.8	.0005
eGFR <60 mL·min⁻¹·1.73 m⁻², n (%)	6 (67)	40 (18)	8.22	2.15-39.3	.002
LAD >40 mm, n (%)	7 (78)	109 (50)	3.10	075-20.84	.12
E/e′ >14, n (%)	3 (33)	44 (20)	2.27	0.48-8.67	.27
LVEF, %	49 ± 12	57 ± 8	0.94	0.90-1.00	.04
AF recurrence, n (%)	4 (44)	52 (24)	0.65	0.16-2.71	.53
Antiarrhythmic drugs, n (%)	5 (56)	73 (33)	2.07	0.54-8.44	.28
ACE-I/ARB, n (%)	4 (44)	84 (39)	1.08	0.26-4.10	.91
β-Blocker, n (%)	6 (67)	78 (36)	3.53	0.92-16.9	.07
DOAC, n (%)	3 (33)	192 (88)	0.051	0.008-0.22	.0001
Statin, n (%)	6 (67)	41 (19)	7.11	1.87-33.7	.004

Abbreviations: ACE-I/ARB, angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker; AF, atrial fibrillation; BNP, B-type natriuretic peptide; CI, confidence interval; DOAC, direct oral anticoagulants; eGFR, estimated glomerular filtration rate; HR, hazard ratio; hs-CRP, high-sensitive C-reactive protein; hs-TnT, high-sensitive troponin T; LAD, left atrial diameter; LVEF, left ventricular ejection fraction.

Table 5. Univariate and multivariate analysis of the predictors of composite endpoint after ablation
	+ (N = 61)	− (N = 166)	Univariate analysis			Multivariate analysis
	+ (N = 61)	− (N = 166)	HR	95% CI	P value	HR	95% CI	P value
Age, y	66 ± 9	65 ± 11	1.01	0.98-1.03	.55	–	–	–
Male, n (%)	37 (61)	119 (72)	0.64	0.38-1.08	.09	–	–	–
Persistent AF, n (%)	37 (61)	61 (37)	2.15	1.29-3.64	.003	2.07	1.24-3.52	.005
Hypertension, n (%)	35 (57)	102 (61)	0.99	0.60-1.67	.97	–	–	–
Ischemic heart disease, n (%)	6 (10)	7 (4)	2.08	0.80-4.47	.12	–	–	–
Previous stroke, n (%)	8 (13)	7 (4)	2.13	0.93-4.24	.07	–	–	–
CHA₂DS₂-VASc score	2.9 ± 1.7	2.3 ± 1.5	1.17	1.00-1.36	.045	1.09	0.92-1.28	.32
hs-CRP, mg/dL	0.12 ± 0.15	0.11 ± 0.17	1.64	0.15-8.55	.62	–	–	–
hs-TnT ≥0.014 μg/L, n (%)	22 (36)	24 (14)	2.24	1.31-3.75	.004	1.91	1.06-3.35	.03
BNP, pg/dL	132 ± 128	91 ± 132	1.00	1.00-1.00	.16	–	–	–
eGFR<60 mL·min⁻¹·1.73 m⁻², n (%)	14 (23)	32 (19)	1.11	0.59-1.96	.73	–	–	–
LAD >40 mm, n (%)	38 (62)	78 (47)	1.47	0.88-2.51	.14	–	–	–
E/e′ >14, n (%)	17 (28)	30 (18)	1.68	0.93-2.90	.08	–	–	–
LVEF, %	55 ± 9	57 ± 7	0.99	0.96-1.02	.43	–	–	–
Cryoballoon ablation, n (%)	8 (13)	42 (25)	0.57	0.25-1.13	.11	–	–	–
ACE-I/ARB, n (%)	21 (34)	67 (40)	0.74	0.43-1.24	.26	–	–	–
β-Blocker, n (%)	25 (41)	59 (36)	1.11	0.66-1.85	.69	–	–	–
DOAC, n (%)	48 (79)	147 (89)	0.58	0.32-1.11	.10	–	–	–
Statin, n (%)	12 (20)	35 (21)	0.89	0.45-1.62	.72	–	–	–
Antiarrhythmic drugs, n (%)	19 (31)	59 (36)	0.75	0.43-1.28	.30	–	–	–

Abbreviations: ACE-I/ARB, angiotensin coverting enzyme inhibitor/angiotensin II receptor blocker; AF, atrial fibrillation; BNP, B-type natriuretic peptide; CI, confidence interval; DOAC, direct oral anticoagulants; eGFR, estimated glomerular filtration rate; HR, hazard ratio; hs-CRP, high-sensitive C-reactive protein; hs-TnT, high-sensitive troponin T; LAD, left atrial diameter; LVEF, left ventricular ejection fraction.

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