This study was performed using data from a single center registry of 2,361 patients with newly detected AF between August 2014 and December 2016 in Kon-Kuk Medical Center, Seoul, Republic of Korea. Therefore, we aimed to explore the prognosis in patients with newly detected AF and concomitant HFpEF and investigate the prognostic utility of hs-cTn for clinical outcomes in patients with both disorders. However, in patients with AF and concomitant HFpEF, the prognostic role of high-sensitivity cardiac troponin has not been established. In patients with HFpEF, cardiac troponin is frequently detectable, and higher level of high-sensitive cardiac troponin (hs-cTn) is associated with risk of adverse cardiovascular outcomes. Several studies have demonstrated a consistent association between elevated cardiac troponin level and risk of adverse cardiovascular outcomes among patients with AF and concomitant HF with reduced ejection fraction (HFrEF), even in the absence of chest pain or myocardial infarction. Therefore, although early risk stratification and integrated care in patients with AF and concomitant HFpEF are important, these are challenging. AF is one of the precedents and predictors of HFpEF, and the advent of AF changes the clinical course of HFpEF by posing a higher risk of associated complications, including thromboembolic events, heart failure exacerbation, and an increase in mortality. The disorders share many common clinical features and are inextricably linked to each other.

The proportion of HFpEF patients with coexisting AF has been reported to range from 15% to as high as 65% in older populations. Heart failure with preserved ejection fraction (HFpEF) accounts for more than half of all hospital admissions for heart failure (HF), and concomitant atrial fibrillation (AF) is frequently observed. This finding suggested that hs-cTnI may be a useful tool in individualized risk stratification of future cardiovascular events in patients with AF and concomitant HFpEF. One-fifth of patients with AF and concomitant HFpEF experienced MACCE during follow-up, and elevated hs-cTnI was independently associated with higher risk of MACCE, as driven by heart failure and revascularization-caused readmission. The incidence of heart failure-caused readmission tended to occur more frequently in the elevated hs-cTnI group (8.5% versus 15.5% adjusted HR, 1.52 95% CI, 0.86–2.67 p = 0.08). In a multivariable Cox regression model, the elevated hs-cTnI group had a higher incidence of MACCE (adjusted hazard ratio, 1.54 95% confidence interval, 1.08–2.55 p = 0.03) and coronary revascularization-caused readmission (adjusted HR, 3.86 95% CI, 1.39–15.09 p = 0.02) compared with the non-elevated hs-cTnI group. During the follow-up period, 106 patients (22.6%) in the study population experienced MACCE. The median follow-up period was 24.2 (interquartile range, 7.5–38.6) months. In 469 patients, 295 were stratified into the non-elevated hs-cTnI group (< 99th percentile URL of hs-cTnI) and 174 were placed in the elevated hs-cTnI group (≥ 99th percentile URL of hs-cTnI). The primary outcome was the incidence of major adverse cardiac and cerebrovascular events (MACCE) during follow-up. Finally, 469 patients are classified into elevated or non-elevated hs-cTnI groups based on the 99th percentile upper reference limit (URL).

Of which, 634 patients were eligible for HFpEF diagnosis (HFA-PEFF score ≥ 5) and 165 patients were excluded with exclusion criteria. Methodsįrom August 2014 to December 2016, 2,361 patients with newly detected AF were polled in a retrospective single-center registry. We aimed to explore the prognostic utility of high-sensitivity cardiac troponin I (hs-cTnI) in patients with newly detected AF and concomitant HFpEF. Limited data are available for risk stratification in patients with atrial fibrillation (AF) and combined heart failure with preserved ejection fraction (HFpEF).

Troponin istat range