Structural Cardiac Abnormalities in Patients with Atrial Fibrillation/Flutter and Myocardial Injury

Laura De Michieli, Ronstan Lobo, Luciano Babuin, Rowlens M. Melduni, Sabino Iliceto, Abhiram Prasad, Yader Sandoval, Allan S. Jaffe

Research output: Contribution to journalArticlepeer-review

Abstract

Background: High-sensitivity cardiac troponin (hs-cTnT) is often increased in patients with atrial fibrillation/flutter, portending a poor prognosis. The etiologies for these increases have not been systematically investigated. Our aim was to define prevalence/significance of structural cardiac abnormalities in patients with atrial fibrillation/flutter and high-sensitivity cardiac troponin T (hs-cTnT) increases. Methods: This is a retrospective observational cohort study of patients with atrial fibrillation/flutter diagnosis with hs-cTnT measurements, echocardiograms, and coronary angiograms. Myocardial injury was defined as hs-cTnT >10 ng/L for women and >15 ng/L for men. Cases with myocardial injury were adjudicated according to the Fourth Universal Definition of Myocardial Infarction. Results: Patients with definite causes for increased hs-cTnT (n = 875) were tabulated but not evaluated further; common diagnoses were type 1 myocardial infarction, critical illness, and known heart failure. Of the remaining 401, increased hs-cTnT was present in 336 (84%) patients. Of those, 78% had nonischemic myocardial injury, the remaining (n = 75, 22%) had type 2 myocardial infarction. Patients with elevated hs-cTnT had greater left ventricular mass index, left ventricular filling pressures, and right ventricular systolic pressure. They more frequently had significant coronary artery disease (47% vs 31%, P = .016), especially in type 2 myocardial infarction. With logistic regression, age, sex (F), diabetes, left ventricular mass index, e′ medial velocity, and right ventricular systolic pressure were independent determinants of myocardial injury. One-year mortality was higher in patients with myocardial injury. Conclusions: Structural heart abnormalities are common in patients with atrial fibrillation/flutter and increased hs-cTnT. Causes of myocardial injury should be elucidated in each patient to craft appropriate therapies.

Original languageEnglish (US)
Pages (from-to)1488-1496.e5
JournalAmerican Journal of Medicine
Volume135
Issue number12
DOIs
StatePublished - Dec 2022

Keywords

  • Atrial fibrillation/flutter
  • High-sensitivity cardiac troponin T
  • Myocardial infarction
  • Myocardial injury
  • Prognosis

ASJC Scopus subject areas

  • Medicine(all)

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