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
DisclosuresJ Cardiovasc Electrophysiol. 2019;30(9):1475-1482.
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.
J Cardiovasc Electrophysiol. 2019;30(9):1475-1482. © 2019 Blackwell Publishing
| Total (N = 227) | hs-TnT (μg/L) | P value | |||
|---|---|---|---|---|---|
| Low: ≤ 0.005 (N = 54) | Medium: 0.006-0.013 (N = 127) | High: ≥ 0.014 (N = 46) | |||
| 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.
| 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.
| hs-TnT (μg/L) | P value | AF recurrence | P value | ||||
|---|---|---|---|---|---|---|---|
| ≤0.005 (N = 54) | 0.006-0.013 (N = 127) | ≥0.014 (N = 46) | + (N = 56) | − (N = 171) | |||
| 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.
| + (N = 9) | − (N = 218) | Univariate analysis | |||
|---|---|---|---|---|---|
| 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.
| + (N = 61) | − (N = 166) | Univariate analysis | Multivariate analysis | |||||
|---|---|---|---|---|---|---|---|---|
| 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.
Shota Tamura MD, Atsushi Doi MD, PhD, Masanori Matsuo MD, Hisashi Katayama MD, Tomotaka Yoshiyama MD, Hiroaki Tatsumi MD, PhD, Yasuhiro Izumiya MD, PhD and Minoru Yoshiyama MD, PhD
Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
Correspondence
Atsushi Doi, MD, PhD, Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka 545-8585, Japan. Email: m1410001@med.osaka-cu.ac.jp
Disclosures
None.
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