Clin Res Cardiol (2021)
DOI DOI https://doi.org/10.1007/s00392-021-01843-w

DGK-Abstract-Preis 2021:
Risk prediction of atrial fibrillation and its complications in the community by high-sensitivity cardiac Troponin I levels: Results from the BiomarCaRE Consortium
C. S. Börschel1, B. Geelhoed1, S. Camen1, T. Niiranen2, A. S. Havulinna2, T. Palosaari2, P. Jousilahti2, J. Kontto2, K. Kuulasmaa2, V. Salomaa2, E. Vartiainen2, S. Blankenberg3, F. Ojeda-Echevarria3, T. Zeller1, L. Iacoviello4, S. Costanzo4, M. B. Donati4, D. G. Giovanni4, F. Gianfagna5, A. Di Castelnuovo6, S. Söderberg7, A. Linneberg8, J. K. Vishram-Nielsen8, M.-L. Løchen9, G. Pasterkamp10, H. M. den Ruijter10, W. König11, T. Jørgensen8, R. Schnabel1, für die Studiengruppe: BiomarCaRE
1Allgemeine und Interventionelle Kardiologie, Universitäres Herz- und Gefäßzentrum Hamburg GmbH, Hamburg; 2Finnish Institute for Health and Welfare, Helsinki, FI; 3Klinik für Kardiologie, Universitäres Herz- und Gefäßzentrum Hamburg GmbH, Hamburg; 4Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, IT; 5Department of Medicine and Surgery, Research Center in Epidemiology and Preventive Medicine (EPIMED), Varese, IT; 6Mediterranea Cardiocentro, Napoli, IT; 7Department of Public Health and Clinical Medicine, Umeå University, Umeå, SE; 8Center for Clinical Research and Disease Prevention, Bispebjerg and Frederiksberg Hospital, Frederiksberg, DK; 9Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, NO; 10Department of Experimental Cardiology, University Medical Center Utrecht, Utrecht, NL; 11Institute of Medical Microbiology, Otto-von-Guericke University, Magdeburg;

Aims-Atrial fibrillation (AF) is becoming increasingly common and is associated with serious complications. Traditional cardiovascular risk factors (CVRF) like age, male sex, hypertension, smoking, diabetes, adiposity and hyperlipidemia do not explain all AF cases. Blood-based biomarkers reflecting cardiac injury may help closing this gap.

Methods-We investigated the predictive ability of high sensitivity troponin I (hsTnI) for incidence of AF in 29,227 participants from different European cohorts on the Biomarkers for Cardiovascular Risk Assessment in Europe (BiomarCaRE) consortium in comparison to CVRF and established biomarkers (high-sensitive C-reactive protein (hsCRP), N-terminal pro B-type natriuretic peptide (NT-proBNP)).

Results-During a median follow-up time of 13.8 (lower and upper quartiles 4.5, 21.3) years 1,509 (5.2%) developed AF. Those in the highest fourth of hsTnI values at baseline (≥ 5.1 ng/L) had a 2.71-fold significantly higher risk for developing AF compared to those in the lowest fourth (≤ 2.1 ng/L). However, in multivariable-adjusted Cox proportional hazard models no statistically significant association was seen between hsTnI and AF, whereas NT-proBNP (hazard ratio (HR) per two-fold increase in NT-proBNP 1.64 ; 95% confidence interval (CI)  1.56, 1.72; P<0.001) as well as hsCRP (HR ratio per two-fold increase in hsCRP 1.05; 95% CI 1.01, 1.10; P=0.01) were significantly related to incident AF. Only the addition of NT-proBNP (C-statistic 0.82 with bootstrapping standard deviation of 0.01) to a CVRF-based model (C-statistic 0.79 with bootstrapping standard deviation of 0.01) enhanced the discriminating value for incident AF (C-statistic for hsTnI + CVRF 0.79 with bootstrapping standard deviation of 0.01). Higher hsTnI concentrations were associated with AF complications such as stroke, heart failure and cardiovascular events as well as overall mortality after diagnosed AF.

Conclusions-hsTnI is associated with AF complications and overall mortality after onset of AF but does not improve AF prediction. NT-proBNP remains the best known biomarker for AF prediction whereas CVRF remain the most important tools in the clinical setting.
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