Velt Marieke J H, van Gelder Isabelle C, Crijns Harry J G M, Rienstra Michiel, Mulder Bart A
Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
Department of Cardiology, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands.
Int J Cardiol. 2025 Nov 15;439:133669. doi: 10.1016/j.ijcard.2025.133669. Epub 2025 Jul 25.
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.
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.
心房颤动（AF）是一种进行性疾病，与相当高的心血管发病率和死亡率相关。这项RACE II研究的事后分析旨在确定与早期永久性房颤心血管发病率和死亡率相关的参数。
在RACE II纳入的614例患者中，543例在基线时有生物标志物数据并纳入本分析。平均年龄为68±8岁，女性占34%。房颤持续时间中位数为18个月，进展为永久性房颤后的持续时间中位数为3个月。101例（19%）患者患有冠状动脉疾病，54例（10%）患者有因心力衰竭住院史。高敏肌钙蛋白T（hs-TnT）和N末端B型利钠肽原（NT-proBNP）的血浆浓度分别为9 pg/ml（四分位间距7-14）和1003 pg/ml（四分位间距634-1632）。主要终点是心血管死亡、因心力衰竭住院、中风、全身性栓塞、大出血和严重心律失常事件的复合终点。随访3年后，共有67例（12.0%）患者达到主要复合结局。多变量调整后，自首次房颤发作以来的时间更长（风险比1.07（95%CI 1.02-1.12），P=0.008）和hs-TnT水平升高（风险比1.64（95%CI 1.25-2.15），p<0.001）与主要结局相关。结论：在早期永久性房颤患者中，自首次房颤发作以来的时间更长和血液生物标志物hs-TnT水平更高是心血管发病率和死亡率的独立决定因素。
