Duration of atrial fibrillation and cardiac biomarkers are associated with cardiovascular outcomes in early permanent atrial fibrillation: Data from the RACE II study.

INTRODUCTION

Atrial fibrillation (AF) is a progressive disease and is associated with considerable cardiovascular morbidity and mortality. This post-hoc analysis of the RACE II study aimed to identify parameters associated with cardiovascular morbidity and mortality in early permanent AF.

METHODS AND RESULTS

Out of the 614 patients included in RACE II, 543 had biomarkers available at baseline and were included in the present analyses. The mean age was 68 ± 8 years and 34 % were women. Median AF duration was 18 months and median duration since progression into permanent AF was 3 months. Coronary artery disease was present in 101 (19 %) patients and 54 (10 %) patients had a history of hospitalization due to heart failure. Plasma concentrations of high sensitive troponin T (hs-TnT) and N-terminal pro B-type natriuretic peptide (NT-proBNP) were 9 pg/ml (interquartile range 7-14) and 1003 pg/ml (interquartile range 634-1632), respectively. The primary endpoint was a composite of cardiovascular death, hospitalization for heart failure, stroke, systemic embolism, major bleeding, and severe arrhythmic events. After a follow-up of 3 years, a total of 67 (12.0 %) patients reached the primary composite outcome. After multivariable adjustment, a longer duration since the first episode of AF (hazard ratio 1.07 (95 % CI 1.02-1.12), P = 0.008) and elevated levels of hs-TnT (hazard ratio 1.64 (95 % CI 1.25-2.15), p < 0.001) were associated with the primary outcome CONCLUSION: In early permanent AF patients, a longer duration since the first episode of AF and a higher level of blood biomarker hs-TnT are independent determinants for cardiovascular morbidity and mortality.