Minor elevations in troponin I are associated with mortality and adverse cardiac events in patients with atrial fibrillation

Background: Extensive of atrial fibrosis has been demonstrated to significantly predict success of catheter ablation. However, impact of extensive fibrosis on other aspects of patient care and long-term prognosis is unknown. Methods: We conducted a historical cohort study to assess the hypothesis that increased degree of atrial fibrosis is independently associated with major adverse cardiac events (MACE). We reviewed 853 patients with non-valvular atrial fibrillation (NVAF) and quantified fibrosis. Logistic regression models were used to evaluate the association of percent fibrosis on experiencing a MACE. Linear splines were utilized to allow the functional form of the exposure to vary at high (>15%) and low (<15%) fibrosis scores. The outcome of interest was a composite of MACE: myocardial infarction (MI), ischemic stroke (IS), or venous thromboembolism (VTE). Results: The mean age of the cohort was 66.2±12.4 with 66% male and 79% white. During a median follow-up of 2.9 years, 69 (8.1%), 46 (5.4%), 52 (6.1%), and 156 (18.3%) of patients experienced an MI, IS, VTE, or MACE, respectively. High fibrosis patients were more likely to be older, male, and have a higher CHA2DS2-VASc score. In the unadjusted analysis, increased fibrosis was associated with increased odds of a MI (OR [95% CI] P-Value: 1.30 [1.00, 1.68] 0.05) or any MACE (1.28 [1.06, 1.56] 0.01), but not with IS or VTE. After adjusting for potential confounders, increasing fibrosis levels had significantly increased odds of MI (1.53 [1.02, 2.28] 0.04) and VTE (1.52 [1.17, 2.86] <0.01) when fibrosis levels were above 15%. There was no significant association below 15%. The odds of a MACE was significant above 15% (1.64 [1.18, 2.27] <0.01) and across all fibrosis scores (1.23 [1.01, 1.49] 0.04), but was insignificant when only fibrosis levels below 15% were examined. Conclusions: Advanced degree of atrial fibrosis in patients with NVAF is independently associated with increased risk of MI, VTE and a composite of MACE.

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Risk of Incident Non-Valvular Atrial Fibrillation after Dialysis-Requiring Acute Kidney Injury

Journal of Clinical Medicine ◽

10.3390/jcm7090248 ◽

2018 ◽

Vol 7 (9) ◽

pp. 248 ◽

Cited By ~ 3

Author(s):

Chih-Chung Shiao ◽

Wei-Chih Kan ◽

Jian-Jhong Wang ◽

Yu-Feng Lin ◽

Likwang Chen ◽

...

Keyword(s):

Atrial Fibrillation ◽

Acute Kidney Injury ◽

De Novo ◽

Kidney Injury ◽

Control Group ◽

Research Database ◽

Cardiac Events ◽

Adverse Cardiac Events ◽

Recovery Group ◽

Group Control Group

The influence of acute kidney injury (AKI) on subsequent incident atrial fibrillation (AF) has not yet been fully addressed. This retrospective nationwide cohort study was conducted using Taiwan’s National Health Insurance Research Database from 1 January 2000 to 31 December 2010. A total of 41,463 patients without a previous AF, mitral valve disease, and hyperthyroidism who developed de novo dialysis-requiring AKI (AKI-D) during their index hospitalization were enrolled. After propensity score matching, “non-recovery group” (n = 2895), “AKI-recovery group” (n = 2895) and “non-AKI group” (control group, n = 5790) were categorized. Within a follow-up period of 6.52 ± 3.88 years (median, 6.87 years), we found that the adjusted risks for subsequent incident AF were increased in both AKI-recovery group (adjusted hazard ratio (aHR) = 1.30; 95% confidence intervals (CI), 1.07–1.58; p ≤ 0.01) and non-recovery group (aHR = 1.62; 95% CI, 1.36–1.94) compared to the non-AKI group. Furthermore, the development of AF carried elevated risks for major adverse cardiac events (aHR = 2.11; 95% CI, 1.83–2.43), ischemic stroke (aHR = 1.33; 95% CI, 1.19–1.49), and all stroke (aHR = 1.28; 95% CI, 1.15–1.43). (all p ≤ 0.001, except otherwise expressed) The authors concluded that AKI-D, even in those who withdrew from temporary dialysis, independently increases the subsequent risk of de novo AF.

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P1215Association of the metabolic syndrome with 5-year major adverse cardiac events in patients with atrial fibrillation: a propensity-score adjusted analysis

EP Europace ◽

10.1093/europace/euy015.697 ◽

2018 ◽

Vol 20 (suppl_1) ◽

pp. i237-i238

Author(s):

M Polovina ◽

D Djikic ◽

A Vlajkovic ◽

M Vilotijevic ◽

P Seferovic

Keyword(s):

Atrial Fibrillation ◽

Metabolic Syndrome ◽

Propensity Score ◽

Major Adverse Cardiac Events ◽

Cardiac Events ◽

Adjusted Analysis ◽

The Metabolic Syndrome ◽

Adverse Cardiac Events

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What is the 30-day rate of adverse cardiac events in chest pain patients with ED troponin I assays≤99th centile using a contemporary sensitive assay? An exploratory analysis

European Journal of Emergency Medicine ◽

10.1097/mej.0000000000000079 ◽

2014 ◽

Vol 21 (4) ◽

pp. 276-280 ◽

Cited By ~ 5

Author(s):

Anne-Maree Kelly ◽

Sharon Klim

Keyword(s):

Chest Pain ◽

Troponin I ◽

Exploratory Analysis ◽

Sensitive Assay ◽

Cardiac Events ◽

Adverse Cardiac Events ◽

Pain Patients

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Potential New Approaches in Predicting Adverse Cardiac Events One Month after Major Vascular Surgery

Medical Principles and Practice ◽

10.1159/000495079 ◽

2018 ◽

Vol 28 (1) ◽

pp. 63-69

Author(s):

Mladjan Golubovic ◽

Velimir Peric ◽

Dragana Stanojevic ◽

Milan Lazarevic ◽

Nenad Jovanovic ◽

...

Keyword(s):

Risk Assessment ◽

Vascular Surgery ◽

Troponin I ◽

Risk Index ◽

Cardiac Complications ◽

Cardiac Events ◽

Preoperative Risk ◽

Adverse Cardiac Events ◽

Creatine Kinase Mb ◽

Major Vascular Surgery

Objective: The aim of our study was to find the best model with sufficient power to improve the risk stratification in major vascular surgery patients during the first 30 days after this procedure. The discriminatory power of 4 biomarkers (troponin I [TnI], N-terminal prohormone of brain natriuretic peptide [NT-proBNP], creatine kinase-MB isoenzyme [CK-MB], high-sensitivity C-reactive protein [hs-CRP]) was tested as well as 2 risk assessment models and 13 different combinations of them. Subjects and Methods: The study included 122 patients (77% men, 23% women) with an average age of 67.03 ± 4.5 years. An aortobifemoral bypass was performed in 6.56% of the patients, a femoropopliteal bypass in 18.85%, and 49.18% received open surgical reconstruction of the carotid arteries. A total of 25.41% of the patients were given an aortobi-iliac bypass. Results: During the first 30 days, 13 patients (10.7%) had 17 cardiac complications. The most common complication was the new onset of atrial fibrillation (35.3%). During the first 10 days, 10 patients had 1 complication and 2 patients had 2 cardiac events, while 1 patient had 3 complications. By comparing combinations of scores and markers, it was shown that revised cardiac risk index (RCRI) + Vascular Portsmouth Physiological and Operative Severity Score (V-POSSUM) + hsTnI and RCRI + V-POSSUM + hsTnI + NT-proBNP with 100% sensitivity, > 80% specificity had the best discriminatory ability (AUC 0.924 and 0.933, respectively; p < 0.001 for both models) for cardiac complications during the 30 days after surgery. Conclusion: Combinations of traditional preoperative risk factors and scores can enhance the assessment of major adverse cardiac events (MACE) in patients preparing for large vascular surgery. Using only one risk score in these patients seems to be underperforming in preoperative risk assessment.

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P1219Statins and the risk of major adverse cardiac events in patients with atrial fibrillation without coronary artery disease: a propensity score adjusted analysis

EP Europace ◽

10.1093/europace/euy015.701 ◽

2018 ◽

Vol 20 (suppl_1) ◽

pp. i239-i239

Author(s):

M Polovina ◽

D Djikic ◽

A Vlajkovic ◽

M Vilotijevic ◽

M C Ostojic ◽

...

Keyword(s):

Atrial Fibrillation ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Propensity Score ◽

Major Adverse Cardiac Events ◽

Cardiac Events ◽

Adjusted Analysis ◽

Adverse Cardiac Events ◽

Artery Disease

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Left atrial dimension and cardiovascular outcomes in patients with and without atrial fibrillation: a systematic review and meta-analysis

Heart ◽

10.1136/heartjnl-2019-315174 ◽

2019 ◽

Vol 105 (24) ◽

pp. 1884-1891 ◽

Cited By ~ 7

Author(s):

Lorin Froehlich ◽

Pascal Meyre ◽

Stefanie Aeschbacher ◽

Steffen Blum ◽

Daniela Djokic ◽

...

Keyword(s):

Atrial Fibrillation ◽

Systematic Review ◽

Left Atrial ◽

Meta Analysis ◽

Cardiovascular Outcomes ◽

Volume Index ◽

Thromboembolic Events ◽

Cardiac Events ◽

Adverse Cardiac Events ◽

Echocardiographic Parameters

ObjectiveThe prognostic value of left atrial (LA) dimensions may differ between patients with and without atrial fibrillation (AF).MethodsMEDLINE and EMBASE were searched for studies that investigated the association between LA echocardiographic parameters measured by transthoracic echocardiography and cardiovascular outcomes in patients with or without AF. Data were independently abstracted by two reviewers and pooled using random-effects meta-analysis. The primary outcome was incident stroke or thromboembolic events. Secondary outcomes were heart failure, all-cause mortality and major adverse cardiac events (MACE).ResultsTwenty-three studies of patients with AF (14 939 patients) and 68 studies of patients without AF (50 720 patients) in this systematic review. Increasing LA diameter was significantly associated with stroke and thromboembolic events in patients without AF (risk ratio (RR) 1.38, 95% CI 1.02 to 1.87; p=0.03), but not in patients with AF (RR 1.02, 95% CI 0.98 to 1.07; p=0.27; p for difference=0.05). Increasing LA diameter index was significantly associated with MACE in patients with AF (RR 1.13, 95% CI 1.09 to 1.17; p<0.001) and in patients without AF (RR 2.98, 95% CI 1.90 to 4.66; p<0.001), with stronger effects in non-AF populations (p for difference <0.001). Greater LA volume index was significantly associated with the risk of MACE in patients with AF (RR 1.01, 95% CI 1.00 to 1.02; p=0.03) and in non-AF populations (RR 1.08, 95% CI 1.05 to 1.10; p<0.001), the association being stronger in individuals without AF (p for difference <0.001).ConclusionsLarger LA parameters were associated with various adverse cardiovascular events. Many of these associations were stronger in individuals without AF, highlighting the potential importance of LA myopathy.

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Atrial fibrillation is associated with increased risk of lethal ventricular arrhythmias

Scientific Reports ◽

10.1038/s41598-021-97335-y ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Yun Gi Kim ◽

Yun Young Choi ◽

Kyung-Do Han ◽

Kyongjin Min ◽

Ha Young Choi ◽

...

Keyword(s):

Atrial Fibrillation ◽

Ventricular Arrhythmias ◽

Population Based ◽

Cardiac Events ◽

Population Based Study ◽

Increased Risk ◽

Adverse Cardiac Events ◽

Korean National Health Insurance ◽

New Onset

AbstractAtrial fibrillation (AF) is associated with various major adverse cardiac events such as ischemic stroke, heart failure, and increased overall mortality. However, its association with lethal ventricular arrhythmias such as ventricular tachycardia (VT), ventricular flutter (VFL), and ventricular fibrillation (VF) is controversial. We conducted this study to determine whether AF can increase the risk of VT, VFL, and VF. We utilized the Korean National Health Insurance Service database for this nationwide population-based study. This study enrolled people who underwent a nationwide health screen in 2009 for whom clinical follow-up data were available until December 2018. Primary outcome endpoint was the occurrence of VT, VFL, or VF in people who were and were not diagnosed with new-onset AF in 2009. We analyzed a total of 9,751,705 people. In 2009, 12,689 people were diagnosed with new-onset AF (AF group). The incidence (events per 1000 person-years of follow-up) of VT, VFL, and VF was 2.472 and 0.282 in the AF and non-AF groups, respectively. After adjustment for covariates, new-onset AF was associated with 4.6-fold increased risk (p < 0.001) of VT, VFL, and VF over 10 years of follow-up. The risk of VT, VFL, and VF was even higher if identification of AF was based on intensified criteria (≥ 2 outpatient records or ≥ 1 inpatient record; hazard ratio = 5.221; p < 0.001). In conclusion, the incidence of VT, VFL, and VF was significantly increased in people with new-onset AF. The potential risk of suffering lethal ventricular arrhythmia in people with AF should be considered in clinical practice.

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