Risk prediction of atrial fibrillation and its complications in the community using hs troponin I

Christin S Börschel; Bastiaan Geelhoed; Teemu Niiranen; Stephan Camen; Maria Benedetta Donati; Aki S Havulinna; Francesco Gianfagna; Tarja Palosaari; Pekka Jousilahti; Jukka Kontto; Erkki Vartiainen; Francisco M Ojeda; Hester M den Ruijter; Simona Costanzo; Giovanni de Gaetano; Augusto Di Castelnuovo; Allan Linneberg; Julie K Vishram-Nielsen; Maja-Lisa Løchen; Wolfgang Koenig; Torben Jørgensen; Kari Kuulasmaa; Stefan Blankenberg; Licia Iacoviello; Tanja Zeller; Stefan Söderberg; Veikko Salomaa; Renate B Schnabel

doi:10.1111/eci.13950

Risk prediction of atrial fibrillation and its complications in the community using hs troponin I

Christin S Börschel, Bastiaan Geelhoed, Teemu Niiranen, Stephan Camen, Maria Benedetta Donati, Aki S Havulinna, Francesco Gianfagna, Tarja Palosaari, Pekka Jousilahti, Jukka Kontto, Erkki Vartiainen, Francisco M Ojeda, Hester M den Ruijter, Simona Costanzo, Giovanni de Gaetano, Augusto Di Castelnuovo, Allan Linneberg, Julie K Vishram-Nielsen, Maja-Lisa Løchen, Wolfgang KoenigTorben Jørgensen, Kari Kuulasmaa, Stefan Blankenberg, Licia Iacoviello, Tanja Zeller, Stefan Söderberg, Veikko Salomaa, Renate B Schnabel^*

^*Corresponding author for this work

2 Citations (Scopus)

Abstract

AIMS: Atrial fibrillation (AF) is becoming increasingly common. Traditional cardiovascular risk factors (CVRF) do not explain all AF cases. Blood-based biomarkers reflecting cardiac injury such as high-sensitivity troponin I (hsTnI) may help close this gap.

METHODS: We investigated the predictive ability of hsTnI for incident AF in 45,298 participants (median age 51.4 years, 45.0% men) across European community cohorts in comparison to CVRF and established biomarkers (C-reactive protein, N-terminal pro B-type natriuretic peptide).

RESULTS: During a median follow-up of 7.7 years, 1,734 (3.8%) participants developed AF. Those in the highest hsTnI quarter (≥ 4.2 ng/L) had a 3.91-fold (95% confidence interval (CI) 3.30, 4.63, P<0.01) risk for developing AF compared to the lowest quarter (<1.4 ng/L). In multivariable-adjusted Cox proportional hazards models a statistically significant association was seen between hsTnI and AF (hazard ratio (HR) per 1 standard deviation (SD) increase in log10(hsTnI) 1.08, 95% CI 1.01, 1.16, P=0.03). Inclusion of hsTnI did improve model discrimination (C-index CVRF 0.811 vs. C-index CVRF and hsTnI 0.813, P<0.01). Higher hsTnI concentrations were associated with heart failure (HR per SD 1.37, 95% CI 1.12, 1.68, P<0.01) and overall mortality (HR per SD 1.24, 95% CI 1.09, 1.41, P<0.01).

CONCLUSION: hsTnI as a biomarker of myocardial injury does not improve prediction of AF incidence beyond classical CVRF and NT-proBNP. However, it is associated with the AF-related disease heart failure and mortality likely reflecting underlying subclinical cardiovascular impairment.

Original language	English
Article number	e13950
Journal	European Journal of Clinical Investigation
Volume	53
Issue number	5
ISSN	0014-2972
DOIs	https://doi.org/10.1111/eci.13950
Publication status	Published - May 2023

Keywords

Atrial Fibrillation/epidemiology
Biomarkers
Female
Heart Failure/epidemiology
Humans
Male
Middle Aged
Natriuretic Peptide, Brain
Peptide Fragments
Risk Factors
Troponin I
N-terminal pro B-type natriuretic peptide
biomarkers
epidemiology
atrial fibrillation
high-sensitivity troponin I

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10.1111/eci.13950

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Börschel, C. S., Geelhoed, B., Niiranen, T., Camen, S., Donati, M. B., Havulinna, A. S., Gianfagna, F., Palosaari, T., Jousilahti, P., Kontto, J., Vartiainen, E., Ojeda, F. M., den Ruijter, H. M., Costanzo, S., de Gaetano, G., Di Castelnuovo, A., Linneberg, A., Vishram-Nielsen, J. K., Løchen, M.-L., ... Schnabel, R. B. (2023). Risk prediction of atrial fibrillation and its complications in the community using hs troponin I. European Journal of Clinical Investigation, 53(5), Article e13950. https://doi.org/10.1111/eci.13950

Börschel, CS, Geelhoed, B, Niiranen, T, Camen, S, Donati, MB, Havulinna, AS, Gianfagna, F, Palosaari, T, Jousilahti, P, Kontto, J, Vartiainen, E, Ojeda, FM, den Ruijter, HM, Costanzo, S, de Gaetano, G, Di Castelnuovo, A, Linneberg, A , Vishram-Nielsen, JK, Løchen, M-L, Koenig, W, Jørgensen, T, Kuulasmaa, K, Blankenberg, S, Iacoviello, L, Zeller, T, Söderberg, S, Salomaa, V & Schnabel, RB 2023, 'Risk prediction of atrial fibrillation and its complications in the community using hs troponin I', European Journal of Clinical Investigation, vol. 53, no. 5, e13950. https://doi.org/10.1111/eci.13950

@article{3c0e7233c1174702b39823a63c7579ca,

title = "Risk prediction of atrial fibrillation and its complications in the community using hs troponin I",

abstract = "AIMS: Atrial fibrillation (AF) is becoming increasingly common. Traditional cardiovascular risk factors (CVRF) do not explain all AF cases. Blood-based biomarkers reflecting cardiac injury such as high-sensitivity troponin I (hsTnI) may help close this gap.METHODS: We investigated the predictive ability of hsTnI for incident AF in 45,298 participants (median age 51.4 years, 45.0\% men) across European community cohorts in comparison to CVRF and established biomarkers (C-reactive protein, N-terminal pro B-type natriuretic peptide).RESULTS: During a median follow-up of 7.7 years, 1,734 (3.8\%) participants developed AF. Those in the highest hsTnI quarter (≥ 4.2 ng/L) had a 3.91-fold (95\% confidence interval (CI) 3.30, 4.63, P<0.01) risk for developing AF compared to the lowest quarter (<1.4 ng/L). In multivariable-adjusted Cox proportional hazards models a statistically significant association was seen between hsTnI and AF (hazard ratio (HR) per 1 standard deviation (SD) increase in log10(hsTnI) 1.08, 95\% CI 1.01, 1.16, P=0.03). Inclusion of hsTnI did improve model discrimination (C-index CVRF 0.811 vs. C-index CVRF and hsTnI 0.813, P<0.01). Higher hsTnI concentrations were associated with heart failure (HR per SD 1.37, 95\% CI 1.12, 1.68, P<0.01) and overall mortality (HR per SD 1.24, 95\% CI 1.09, 1.41, P<0.01).CONCLUSION: hsTnI as a biomarker of myocardial injury does not improve prediction of AF incidence beyond classical CVRF and NT-proBNP. However, it is associated with the AF-related disease heart failure and mortality likely reflecting underlying subclinical cardiovascular impairment.",

keywords = "Atrial Fibrillation/epidemiology, Biomarkers, Female, Heart Failure/epidemiology, Humans, Male, Middle Aged, Natriuretic Peptide, Brain, Peptide Fragments, Risk Factors, Troponin I, N-terminal pro B-type natriuretic peptide, biomarkers, epidemiology, atrial fibrillation, high-sensitivity troponin I",

author = "B{\"o}rschel, \{Christin S\} and Bastiaan Geelhoed and Teemu Niiranen and Stephan Camen and Donati, \{Maria Benedetta\} and Havulinna, \{Aki S\} and Francesco Gianfagna and Tarja Palosaari and Pekka Jousilahti and Jukka Kontto and Erkki Vartiainen and Ojeda, \{Francisco M\} and \{den Ruijter\}, \{Hester M\} and Simona Costanzo and \{de Gaetano\}, Giovanni and \{Di Castelnuovo\}, Augusto and Allan Linneberg and Vishram-Nielsen, \{Julie K\} and Maja-Lisa L{\o}chen and Wolfgang Koenig and Torben J{\o}rgensen and Kari Kuulasmaa and Stefan Blankenberg and Licia Iacoviello and Tanja Zeller and Stefan S{\"o}derberg and Veikko Salomaa and Schnabel, \{Renate B\}",

year = "2023",

month = may,

doi = "10.1111/eci.13950",

language = "English",

volume = "53",

journal = "European Journal of Clinical Investigation",

issn = "0014-2972",

publisher = "John Wiley and Sons Inc.",

number = "5",

}

TY - JOUR

T1 - Risk prediction of atrial fibrillation and its complications in the community using hs troponin I

AU - Börschel, Christin S

AU - Geelhoed, Bastiaan

AU - Niiranen, Teemu

AU - Camen, Stephan

AU - Donati, Maria Benedetta

AU - Havulinna, Aki S

AU - Gianfagna, Francesco

AU - Palosaari, Tarja

AU - Jousilahti, Pekka

AU - Kontto, Jukka

AU - Vartiainen, Erkki

AU - Ojeda, Francisco M

AU - den Ruijter, Hester M

AU - Costanzo, Simona

AU - de Gaetano, Giovanni

AU - Di Castelnuovo, Augusto

AU - Linneberg, Allan

AU - Vishram-Nielsen, Julie K

AU - Løchen, Maja-Lisa

AU - Koenig, Wolfgang

AU - Jørgensen, Torben

AU - Kuulasmaa, Kari

AU - Blankenberg, Stefan

AU - Iacoviello, Licia

AU - Zeller, Tanja

AU - Söderberg, Stefan

AU - Salomaa, Veikko

AU - Schnabel, Renate B

PY - 2023/5

Y1 - 2023/5

N2 - AIMS: Atrial fibrillation (AF) is becoming increasingly common. Traditional cardiovascular risk factors (CVRF) do not explain all AF cases. Blood-based biomarkers reflecting cardiac injury such as high-sensitivity troponin I (hsTnI) may help close this gap.METHODS: We investigated the predictive ability of hsTnI for incident AF in 45,298 participants (median age 51.4 years, 45.0% men) across European community cohorts in comparison to CVRF and established biomarkers (C-reactive protein, N-terminal pro B-type natriuretic peptide).RESULTS: During a median follow-up of 7.7 years, 1,734 (3.8%) participants developed AF. Those in the highest hsTnI quarter (≥ 4.2 ng/L) had a 3.91-fold (95% confidence interval (CI) 3.30, 4.63, P<0.01) risk for developing AF compared to the lowest quarter (<1.4 ng/L). In multivariable-adjusted Cox proportional hazards models a statistically significant association was seen between hsTnI and AF (hazard ratio (HR) per 1 standard deviation (SD) increase in log10(hsTnI) 1.08, 95% CI 1.01, 1.16, P=0.03). Inclusion of hsTnI did improve model discrimination (C-index CVRF 0.811 vs. C-index CVRF and hsTnI 0.813, P<0.01). Higher hsTnI concentrations were associated with heart failure (HR per SD 1.37, 95% CI 1.12, 1.68, P<0.01) and overall mortality (HR per SD 1.24, 95% CI 1.09, 1.41, P<0.01).CONCLUSION: hsTnI as a biomarker of myocardial injury does not improve prediction of AF incidence beyond classical CVRF and NT-proBNP. However, it is associated with the AF-related disease heart failure and mortality likely reflecting underlying subclinical cardiovascular impairment.

AB - AIMS: Atrial fibrillation (AF) is becoming increasingly common. Traditional cardiovascular risk factors (CVRF) do not explain all AF cases. Blood-based biomarkers reflecting cardiac injury such as high-sensitivity troponin I (hsTnI) may help close this gap.METHODS: We investigated the predictive ability of hsTnI for incident AF in 45,298 participants (median age 51.4 years, 45.0% men) across European community cohorts in comparison to CVRF and established biomarkers (C-reactive protein, N-terminal pro B-type natriuretic peptide).RESULTS: During a median follow-up of 7.7 years, 1,734 (3.8%) participants developed AF. Those in the highest hsTnI quarter (≥ 4.2 ng/L) had a 3.91-fold (95% confidence interval (CI) 3.30, 4.63, P<0.01) risk for developing AF compared to the lowest quarter (<1.4 ng/L). In multivariable-adjusted Cox proportional hazards models a statistically significant association was seen between hsTnI and AF (hazard ratio (HR) per 1 standard deviation (SD) increase in log10(hsTnI) 1.08, 95% CI 1.01, 1.16, P=0.03). Inclusion of hsTnI did improve model discrimination (C-index CVRF 0.811 vs. C-index CVRF and hsTnI 0.813, P<0.01). Higher hsTnI concentrations were associated with heart failure (HR per SD 1.37, 95% CI 1.12, 1.68, P<0.01) and overall mortality (HR per SD 1.24, 95% CI 1.09, 1.41, P<0.01).CONCLUSION: hsTnI as a biomarker of myocardial injury does not improve prediction of AF incidence beyond classical CVRF and NT-proBNP. However, it is associated with the AF-related disease heart failure and mortality likely reflecting underlying subclinical cardiovascular impairment.

KW - Atrial Fibrillation/epidemiology

KW - Biomarkers

KW - Female

KW - Heart Failure/epidemiology

KW - Humans

KW - Male

KW - Middle Aged

KW - Natriuretic Peptide, Brain

KW - Peptide Fragments

KW - Risk Factors

KW - Troponin I

KW - N-terminal pro B-type natriuretic peptide

KW - biomarkers

KW - epidemiology

KW - atrial fibrillation

KW - high-sensitivity troponin I

UR - https://www.scopus.com/pages/publications/85146341064

U2 - 10.1111/eci.13950

DO - 10.1111/eci.13950

M3 - Journal article

C2 - 36602448

SN - 0014-2972

VL - 53

JO - European Journal of Clinical Investigation

JF - European Journal of Clinical Investigation

IS - 5

M1 - e13950

ER -

Risk prediction of atrial fibrillation and its complications in the community using hs troponin I

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