Risk prediction of atrial fibrillation and its complications in the community using hs troponin I

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  • Christin S. Börschel
  • Bastiaan Geelhoed
  • Teemu Niiranen
  • Stephan Camen
  • Maria Benedetta Donati
  • Aki S. Havulinna
  • Francesco Gianfagna
  • Tarja Palosaari
  • Pekka Jousilahti
  • Jukka Kontto
  • Erkki Vartiainen
  • Francisco M. Ojeda
  • Hester M. den Ruijter
  • Simona Costanzo
  • Giovanni de Gaetano
  • Augusto Di Castelnuovo
  • Julie K. Vishram-Nielsen
  • Maja Lisa Løchen
  • Wolfgang Koenig
  • Torben Jørgensen
  • Kari Kuulasmaa
  • Stefan Blankenberg
  • Licia Iacoviello
  • Tanja Zeller
  • Stefan Söderberg
  • Veikko Salomaa
  • Renate B. Schnabel

Aims: Atrial fibrillation (AF) is becoming increasingly common. Traditional cardiovascular risk factors (CVRF) do not explain all AF cases. Blood-based biomarkers reflecting cardiac injury such as high-sensitivity troponin I (hsTnI) may help close this gap. Methods: We investigated the predictive ability of hsTnI for incident AF in 45,298 participants (median age 51.4 years, 45.0% men) across European community cohorts in comparison to CVRF and established biomarkers (C-reactive protein, N-terminal pro B-type natriuretic peptide). Results: During a median follow-up of 7.7 years, 1734 (3.8%) participants developed AF. Those in the highest hsTnI quarter (≥4.2 ng/L) had a 3.91-fold (95% confidence interval (CI) 3.30, 4.63; p <.01) risk for developing AF compared to the lowest quarter (<1.4 ng/L). In multivariable-adjusted Cox proportional hazards models a statistically significant association was seen between hsTnI and AF (hazard ratio (HR) per 1 standard deviation (SD) increase in log10(hsTnI) 1.08; 95% CI 1.01, 1.16; p =.03). Inclusion of hsTnI did improve model discrimination (C-index CVRF 0.811 vs. C-index CVRF and hsTnI 0.813; p <.01). Higher hsTnI concentrations were associated with heart failure (HR per SD 1.37; 95% CI 1.12, 1.68; p <.01) and overall mortality (HR per SD 1.24; 95% CI 1.09, 1.41; p <.01). Conclusion: hsTnI as a biomarker of myocardial injury does not improve prediction of AF incidence beyond classical CVRF and NT-proBNP. However, it is associated with the AF-related disease heart failure and mortality likely reflecting underlying subclinical cardiovascular impairment.

Original languageEnglish
Article numbere13950
JournalEuropean Journal of Clinical Investigation
Volume53
Issue number5
Number of pages9
ISSN0014-2972
DOIs
Publication statusPublished - 2023

Bibliographical note

Publisher Copyright:
© 2023 The Authors. European Journal of Clinical Investigation published by John Wiley & Sons Ltd on behalf of Stichting European Society for Clinical Investigation Journal Foundation.

    Research areas

  • atrial fibrillation, biomarkers, epidemiology, high-sensitivity troponin I, N-terminal pro B-type natriuretic peptide

ID: 334263512