Thelin Johan, Melander Olle
Department of Clinical Sciences, Lund University, Lund, Sweden.
Present address: Department of Internal Medicine, Skåne University Hospital, Akutmottagningen, Klinikgatan 15, 2285, Lund, Sweden.
BMC Cardiovasc Disord. 2017 Jun 27;17(1):169. doi: 10.1186/s12872-017-0601-7.
Since the introduction of high-sensitivity troponin assays a greater proportion of atrial fibrillation (AF) patients present with dynamic troponin elevations. We hypothesize that significant coronary artery disease (CAD) causes relative ischemia in the setting of a rapid heart rate resulting in dynamic troponin elevation. The aim of this study was to examine if patients without known CAD who present with AF, tachycardia and dynamic high-sensitivity troponin T (hsTnT) change have an increased risk of cardiac events.
We retrospectively included AF patients presenting with tachycardia during one year. The primary endpoint was acute coronary syndrome, revascularization or death due to ischemic heart disease during 30 months follow-up.
Five hundred twenty-two patients without known CAD were included, 300 (57%) had normal hsTnT and 49 (9.5%) had dynamic hsTnT elevation. During follow-up 12 (4%) patients with normal hsTnT reached the primary endpoint and a total of 14 (4.7%) patients died. In the group with dynamic hsTnT the results were 4 (8.2%) and 12 (25%) respectively. The age-adjusted hazard ratio (HR) for the primary endpoint in patients with dynamic hsTnT was 1.9 (95% CI: 0.6 to 6.2; p = 0.28) and for all-cause mortality 3.8 (95% CI: 1.7 to 8.5; p = 0.001).
Dynamic hsTnT elevation in connection with AF might not be associated with any major increased risk of coronary events, but indicates increased all-cause mortality.
自从高敏肌钙蛋白检测方法问世以来，心房颤动（AF）患者中出现动态肌钙蛋白升高的比例更高了。我们推测，严重冠状动脉疾病（CAD）在心率较快的情况下会导致相对缺血，从而引起动态肌钙蛋白升高。本研究的目的是检验，在无已知CAD但出现AF、心动过速和动态高敏肌钙蛋白T（hsTnT）变化的患者中，心脏事件风险是否增加。
方法我们回顾性纳入了一年内出现心动过速的AF患者。主要终点事件为30个月随访期间发生的急性冠状动脉综合征、血运重建或缺血性心脏病导致的死亡。
结果纳入了522例无已知CAD的患者，其中hsTnT正常者300例（57%），hsTnT动态升高者49例（9.5%）。随访期间，hsTnT正常的患者中有12例（4%）达到主要终点事件，共有14例（4.7%）患者死亡。在hsTnT动态升高组中，相应结果分别为4例（8.2%）和12例（25%）。hsTnT动态升高的患者发生主要终点事件的年龄校正风险比（HR）为1.9（95% CI：0.6至6.2；p = 0.28），全因死亡率的HR为3.8（95% CI：1.7至8.5；p = 0.001）。
与AF相关的hsTnT动态升高可能与冠状动脉事件风险的任何重大增加无关，但提示全因死亡率增加。
