Hussein Ayman A, Bartz Traci M, Gottdiener John S, Sotoodehnia Nona, Heckbert Susan R, Lloyd-Jones Donald, Kizer Jorge R, Christenson Robert, Wazni Oussama, deFilippi Christopher
Cleveland Clinic Foundation, Cleveland, Ohio.
University of Washington, Seattle, Washington.
Heart Rhythm. 2015 May;12(5):879-85. doi: 10.1016/j.hrthm.2015.01.020. Epub 2015 Jan 17.
Various mechanisms in cardiac remodeling related to atrial fibrillation (AF) lead to elevated circulating cardiac troponin levels, but little is known about such elevations upstream to AF onset.
The purpose of this study was to study the association between circulating troponin levels as assessed by a highly sensitive cardiac troponin T (hs-cTnT) assay and incident atrial fibrillation (AF).
In a large prospective cohort of ambulatory older adults [the Cardiovascular Health Study (CHS)], hs-cTnT levels were measured in sera that were collected at enrollment from 4262 participants without AF (2871 with follow-up measurements). Incident AF was identified by electrocardiograms during CHS visits, hospital discharge diagnoses, and Medicare files, including outpatient and physician claims diagnoses.
Over median follow-up of 11.2 years (interquartile range 6.1-16.5), 1363 participants (32.0%) developed AF. Higher baseline levels of hs-cTnT were associated with incident AF in covariate-adjusted analyses accounting for demographics, traditional risk factors, and incident heart failure in time-dependent analyzes (hazard ratio for 3rd tertile vs undetectable 1.75, 95% confidence interval 1.48-2.08). This association was statistically significant in analyses that additionally adjusted for biomarkers of inflammation and hemodynamic strain (hazard ratio for 3rd tertile vs undetectable 1.38, 95% confidence interval 1.16-1.65). Significant associations were also found when hs-cTnT levels were treated as a continuous variable and when examining change from baseline of hs-cTnT levels and incident AF.
The findings show a significant association of circulating troponin levels in ambulatory older adults with incident AF beyond that of traditional risk factors, incident heart failure, and biomarkers of inflammation and hemodynamic strain.
心房颤动（AF）相关的心脏重塑中的各种机制会导致循环心肌肌钙蛋白水平升高，但对于AF发作上游的此类升高情况知之甚少。
本研究的目的是研究通过高敏心肌肌钙蛋白T（hs-cTnT）检测评估的循环肌钙蛋白水平与新发心房颤动（AF）之间的关联。
在一个大型的非卧床老年人前瞻性队列[心血管健康研究（CHS）]中，对4262名无AF的参与者（2871名进行了随访测量）入组时采集的血清进行hs-cTnT水平检测。通过CHS访视期间的心电图、出院诊断和医疗保险档案（包括门诊和医生索赔诊断）确定新发AF。
在中位随访11.2年（四分位间距6.1 - 16.5年）期间，1363名参与者（32.0%）发生了AF。在考虑人口统计学、传统危险因素和时间依赖性分析中的新发心力衰竭的协变量调整分析中，较高的hs-cTnT基线水平与新发AF相关（第三三分位数与不可检测值相比的风险比为1.75，95%置信区间1.48 - 2.08）。在进一步调整炎症和血流动力学应激生物标志物的分析中，这种关联具有统计学意义（第三三分位数与不可检测值相比的风险比为1.38，95%置信区间1.16 - 1.65）。当将hs-cTnT水平视为连续变量以及检查hs-cTnT水平和新发AF的基线变化时，也发现了显著关联。
研究结果表明，非卧床老年人中循环肌钙蛋白水平与新发AF之间存在显著关联，超出了传统危险因素、新发心力衰竭以及炎症和血流动力学应激生物标志物的关联。
