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

doi:10.1016/j.amjmed.2022.06.005

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

Am J Med. 2022 Dec;135(12):1488-1496.e5. doi: 10.1016/j.amjmed.2022.06.005. Epub 2022 Jul 10.

Authors

Laura De Michieli¹, Ronstan Lobo², Luciano Babuin³, Rowlens M Melduni², Sabino Iliceto³, Abhiram Prasad², Yader Sandoval², Allan S Jaffe⁴

Affiliations

¹ Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA; Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Italy.
² Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA.
³ Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Italy.
⁴ Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA. Electronic address: jaffe.allan@mayo.edu.

PMID: 35830903
DOI: 10.1016/j.amjmed.2022.06.005

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.

Keywords: Atrial fibrillation/flutter; High-sensitivity cardiac troponin T; Myocardial infarction; Myocardial injury; Prognosis.

Publication types

Observational Study

MeSH terms

Atrial Fibrillation* / complications
Atrial Fibrillation* / diagnosis
Atrial Fibrillation* / epidemiology
Atrial Flutter* / therapy
Biomarkers
Cohort Studies
Diabetes Mellitus, Type 2*
Female
Heart Injuries*
Humans
Male
Myocardial Infarction* / complications
Myocardial Infarction* / diagnosis
Myocardial Infarction* / epidemiology
Troponin T

Substances

Troponin T
Biomarkers