Skip to main content
Erschienen in: Heart and Vessels 7/2023

23.02.2023 | Original Article

Low troponin I levels predict the presence of arrhythmia-induced cardiomyopathy in patients with atrial fibrillation and left ventricular systolic dysfunction

verfasst von: Daisetsu Aoyama, Shinsuke Miyazaki, Toshihiko Tsuji, Ryohei Nomura, Shota Kakehashi, Moe Mukai, Hiroyuki Ikeda, Kentaro Ishida, Hiroyasu Uzui, Hiroshi Tada

Erschienen in: Heart and Vessels | Ausgabe 7/2023

Einloggen, um Zugang zu erhalten

Abstract

Successful atrial fibrillation (AF) ablation can improve reduced left ventricular ejection fraction (LVEF) with AF, which is defined as arrhythmia-induced cardiomyopathy (AIC). However, it is difficult to pre-procedurally predict the presence of AIC. We aimed to explore the pre-procedural predictors of AIC in patients with AF and reduced LVEF. This study included 60 patients with a reduced LVEF (LVEF < 50%; 69.1 ± 8.8 years; 45 men) who underwent successful AF ablation. Responders were defined as patients whose LVEF post-procedurally improved to the normal range (≥ 50%). Multivariate analysis revealed that the log-transformed pre-procedural troponin I (TnI) levels (odds ratio [OR] = 0.059; 95% confidence interval [CI] = 0.0052–0.42, p = 0.003) and age (OR = 0.91; 95% CI = 0.82–1.00, p = 0.044) were independent predictors of post-procedural LVEF recovery; further, low TnI levels (< 11.1 pg/ml) predicted LVEF recovery (sensitivity, 79.1%; specificity, 76.5%; positive predictive value, 89.5%; and negative predictive value, 59.1%). There were no significant differences in TnI levels between the baseline and 1 month after the procedure. However, four patients with high baseline TnI levels showed a > 50% reduction in the TnI levels post-procedurally, with three of these patients showing LVEF recovery. Low pre-procedural TnI levels can predict LVEF recovery after successful AF ablation in patients with reduced LVEF.
Literatur
1.
Zurück zum Zitat Marrouche NF, Brachmann J, Andresen D, Siebels J, Boersma L, Jordaens L, Merkely B, Pokushalov E, Sanders P, Proff J, Schunkert H, Christ H, Vogt J, Bänsch D (2018) Catheter ablation for atrial fibrillation with heart failure. N Engl J Med 378(5):417–427 CrossRefPubMed Marrouche NF, Brachmann J, Andresen D, Siebels J, Boersma L, Jordaens L, Merkely B, Pokushalov E, Sanders P, Proff J, Schunkert H, Christ H, Vogt J, Bänsch D (2018) Catheter ablation for atrial fibrillation with heart failure. N Engl J Med 378(5):417–427 CrossRefPubMed
2.
Zurück zum Zitat McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, Burri H, Butler J, Čelutkienė J, Chioncel O, Cleland JGF, Coats AJS, Crespo-Leiro MG, Farmakis D, Gilard M, Heymans S, Hoes AW, Jaarsma T, Jankowska EA, Lainscak M, Lam CSP, Lyon AR, McMurray JJV, Mebazaa A, Mindham R, Muneretto C, Piepoli MF, Price S, Rosano GMC, Ruschitzka F, Skibelund AK (2021) 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 42(36):3599–3726 CrossRefPubMed McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, Burri H, Butler J, Čelutkienė J, Chioncel O, Cleland JGF, Coats AJS, Crespo-Leiro MG, Farmakis D, Gilard M, Heymans S, Hoes AW, Jaarsma T, Jankowska EA, Lainscak M, Lam CSP, Lyon AR, McMurray JJV, Mebazaa A, Mindham R, Muneretto C, Piepoli MF, Price S, Rosano GMC, Ruschitzka F, Skibelund AK (2021) 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 42(36):3599–3726 CrossRefPubMed
3.
Zurück zum Zitat Nogami A, Kurita T, Abe H, Ando K, Ishikawa T, Imai K, Usui A, Okishige K, Kusano K, Kumagai K, Goya M, Kobayashi Y, Shimizu A, Shimizu W, Shoda M, Sumitomo N, Seo Y, Takahashi A, Tada H, Naito S, Nakazato Y, Nishimura T, Nitta T, Niwano S, Hagiwara N, Murakawa Y, Yamane T, Aiba T, Inoue K, Iwasaki Y, Inden Y, Uno K, Ogano M, Kimura M, Sakamoto S, Sasaki S, Satomi K, Shiga T, Suzuki T, Sekiguchi Y, Soejima K, Takagi M, Chinushi M, Nishi N, Noda T, Hachiya H, Mitsuno M, Mitsuhashi T, Miyauchi Y, Miyazaki A, Morimoto T, Yamasaki H, Aizawa Y, Ohe T, Kimura T, Tanemoto K, Tsutsui H, Mitamura H (2021) JCS/JHRS 2019 guideline on non-pharmacotheraopy of cardiac arrhythmias. J Arrhythm 37(4):709–870 CrossRefPubMedPubMedCentral Nogami A, Kurita T, Abe H, Ando K, Ishikawa T, Imai K, Usui A, Okishige K, Kusano K, Kumagai K, Goya M, Kobayashi Y, Shimizu A, Shimizu W, Shoda M, Sumitomo N, Seo Y, Takahashi A, Tada H, Naito S, Nakazato Y, Nishimura T, Nitta T, Niwano S, Hagiwara N, Murakawa Y, Yamane T, Aiba T, Inoue K, Iwasaki Y, Inden Y, Uno K, Ogano M, Kimura M, Sakamoto S, Sasaki S, Satomi K, Shiga T, Suzuki T, Sekiguchi Y, Soejima K, Takagi M, Chinushi M, Nishi N, Noda T, Hachiya H, Mitsuno M, Mitsuhashi T, Miyauchi Y, Miyazaki A, Morimoto T, Yamasaki H, Aizawa Y, Ohe T, Kimura T, Tanemoto K, Tsutsui H, Mitamura H (2021) JCS/JHRS 2019 guideline on non-pharmacotheraopy of cardiac arrhythmias. J Arrhythm 37(4):709–870 CrossRefPubMedPubMedCentral
4.
Zurück zum Zitat Prabhu S, Taylor AJ, Costello BT, Kaye DM, McLellan AJA, Voskoboinik A, Sugumar H, Lockwood SM, Stokes MB, Pathik B, Nalliah CJ, Wong GR, Azzopardi SM, Gutman SJ, Lee G, Layland J, Mariani JA, Ling LH, Kalman JM, Kistler PM (2017) Catheter ablation versus medical rate control in atrial fibrillation and systolic dysfunction: the CAMERA-MRI study. J Am Coll Cardiol 70(16):1949–1961 CrossRefPubMed Prabhu S, Taylor AJ, Costello BT, Kaye DM, McLellan AJA, Voskoboinik A, Sugumar H, Lockwood SM, Stokes MB, Pathik B, Nalliah CJ, Wong GR, Azzopardi SM, Gutman SJ, Lee G, Layland J, Mariani JA, Ling LH, Kalman JM, Kistler PM (2017) Catheter ablation versus medical rate control in atrial fibrillation and systolic dysfunction: the CAMERA-MRI study. J Am Coll Cardiol 70(16):1949–1961 CrossRefPubMed
5.
Zurück zum Zitat Ichijo S, Miyazaki S, Kusa S, Nakamura H, Hachiya H, Kajiyama T, Iesaka Y (2018) Impact of catheter ablation of atrial fibrillation on long-term clinical outcomes in patients with heart failure. J Cardiol 72(3):240–246 CrossRefPubMed Ichijo S, Miyazaki S, Kusa S, Nakamura H, Hachiya H, Kajiyama T, Iesaka Y (2018) Impact of catheter ablation of atrial fibrillation on long-term clinical outcomes in patients with heart failure. J Cardiol 72(3):240–246 CrossRefPubMed
6.
Zurück zum Zitat Aoyama D, Miyazaki S, Hasegawa K, Kaseno K, Ishikawa E, Mukai M, Nodera M, Miyahara K, Matsui A, Shiomi Y, Tama N, Ikeda H, Fukuoka Y, Morishita T, Ishida K, Uzui H, Tada H (2020) Preprocedural troponin T levels predict the improvement in the left ventricular ejection fraction after catheter ablation of atrial fibrillation/flutter. J Am Heart Assoc 9(7):e015126 CrossRefPubMedPubMedCentral Aoyama D, Miyazaki S, Hasegawa K, Kaseno K, Ishikawa E, Mukai M, Nodera M, Miyahara K, Matsui A, Shiomi Y, Tama N, Ikeda H, Fukuoka Y, Morishita T, Ishida K, Uzui H, Tada H (2020) Preprocedural troponin T levels predict the improvement in the left ventricular ejection fraction after catheter ablation of atrial fibrillation/flutter. J Am Heart Assoc 9(7):e015126 CrossRefPubMedPubMedCentral
7.
Zurück zum Zitat Vera A, Cecconi A, Martínez-Vives P, Olivera MJ, Hernández S, López-Melgar B, Rojas-González A, Díez-Villanueva P, Salamanca J, Tejelo J, Caballero P, Jiménez-Borreguero LJ, Alfonso F (2022) Electrocardiogram and CMR to differentiate tachycardia-induced cardiomyopathy from dilated cardiomyopathy in patients admitted for heart failure. Heart Vessels 37(11):1850–1858 CrossRefPubMed Vera A, Cecconi A, Martínez-Vives P, Olivera MJ, Hernández S, López-Melgar B, Rojas-González A, Díez-Villanueva P, Salamanca J, Tejelo J, Caballero P, Jiménez-Borreguero LJ, Alfonso F (2022) Electrocardiogram and CMR to differentiate tachycardia-induced cardiomyopathy from dilated cardiomyopathy in patients admitted for heart failure. Heart Vessels 37(11):1850–1858 CrossRefPubMed
8.
Zurück zum Zitat Nishikawa Y, Takaoka H, Kanaeda T, Takahira H, Suzuki S, Aoki S, Goto H, Suzuki K, Yashima S, Takahashi M, Kinoshita M, Sakai H, Suzuki-Eguchi N, Sano K, Kobayashi Y (2022) A new composite indicator consisting of left ventricular extracellular volume, N-terminal fragment of B-type natriuretic peptide, and left ventricular end-diastolic volume is useful for predicting reverse remodeling after catheter ablation for atrial fibrillation. Heart Vessel. https://​doi.​org/​10.​1007/​s00380-022-02220-x CrossRef Nishikawa Y, Takaoka H, Kanaeda T, Takahira H, Suzuki S, Aoki S, Goto H, Suzuki K, Yashima S, Takahashi M, Kinoshita M, Sakai H, Suzuki-Eguchi N, Sano K, Kobayashi Y (2022) A new composite indicator consisting of left ventricular extracellular volume, N-terminal fragment of B-type natriuretic peptide, and left ventricular end-diastolic volume is useful for predicting reverse remodeling after catheter ablation for atrial fibrillation. Heart Vessel. https://​doi.​org/​10.​1007/​s00380-022-02220-x CrossRef
9.
Zurück zum Zitat Shah AS, Griffiths M, Lee KK, McAllister DA, Hunter AL, Ferry AV, Cruikshank A, Reid A, Stoddart M, Strachan F, Walker S, Collinson PO, Apple FS, Gray AJ, Fox KA, Newby DE, Mills NL (2015) High sensitivity cardiac troponin and the under-diagnosis of myocardial infarction in women: prospective cohort study. BMJ 350:g7873 CrossRefPubMedPubMedCentral Shah AS, Griffiths M, Lee KK, McAllister DA, Hunter AL, Ferry AV, Cruikshank A, Reid A, Stoddart M, Strachan F, Walker S, Collinson PO, Apple FS, Gray AJ, Fox KA, Newby DE, Mills NL (2015) High sensitivity cardiac troponin and the under-diagnosis of myocardial infarction in women: prospective cohort study. BMJ 350:g7873 CrossRefPubMedPubMedCentral
10.
Zurück zum Zitat Aakre KM, Røraas T, Petersen PH, Svarstad E, Sellevoll H, Skadberg Ø, Sæle K, Sandberg S (2014) Weekly and 90-minute biological variations in cardiac troponin T and cardiac troponin I in hemodialysis patients and healthy controls. Clin Chem 60(6):838–847 CrossRefPubMed Aakre KM, Røraas T, Petersen PH, Svarstad E, Sellevoll H, Skadberg Ø, Sæle K, Sandberg S (2014) Weekly and 90-minute biological variations in cardiac troponin T and cardiac troponin I in hemodialysis patients and healthy controls. Clin Chem 60(6):838–847 CrossRefPubMed
11.
Zurück zum Zitat Welsh P, Preiss D, Hayward C, Shah ASV, McAllister D, Briggs A, Boachie C, McConnachie A, Padmanabhan S, Welsh C, Woodward M, Campbell A, Porteous D, Mills NL, Sattar N (2019) Carduac troponin T and troponin I in the general population. Circulation 139(24):2754–2764 CrossRefPubMedPubMedCentral Welsh P, Preiss D, Hayward C, Shah ASV, McAllister D, Briggs A, Boachie C, McConnachie A, Padmanabhan S, Welsh C, Woodward M, Campbell A, Porteous D, Mills NL, Sattar N (2019) Carduac troponin T and troponin I in the general population. Circulation 139(24):2754–2764 CrossRefPubMedPubMedCentral
12.
Zurück zum Zitat Lippi G, Tessitore N, Montagnana M, Salvago GL, Lupo A, Guidi GC (2008) Influence of sampling time and ultrafilration coefficient of the dialysis membrane on cardiac troponin I and T. Arch Pathol Lab Med 132(1):72–76 CrossRefPubMed Lippi G, Tessitore N, Montagnana M, Salvago GL, Lupo A, Guidi GC (2008) Influence of sampling time and ultrafilration coefficient of the dialysis membrane on cardiac troponin I and T. Arch Pathol Lab Med 132(1):72–76 CrossRefPubMed
13.
Zurück zum Zitat Maeda K, Tsutamoto T, Wada A, Mabuchi N, Hayashi M, Tsutsui T, Ohnishi M, Sawaki M, Fujii M, Matsumoto T, Kinoshita M (2000) High levels of plasma brain natriuretic peptide and interleukin-6 after optimized treatment for heart failure are independent risk factors for morbidity and mortality in patients with congestive heart failure. J Am Coll Cardiol 36(5):1587–1593 CrossRefPubMed Maeda K, Tsutamoto T, Wada A, Mabuchi N, Hayashi M, Tsutsui T, Ohnishi M, Sawaki M, Fujii M, Matsumoto T, Kinoshita M (2000) High levels of plasma brain natriuretic peptide and interleukin-6 after optimized treatment for heart failure are independent risk factors for morbidity and mortality in patients with congestive heart failure. J Am Coll Cardiol 36(5):1587–1593 CrossRefPubMed
14.
Zurück zum Zitat Savarese G, Vedin O, D’Amario D, Uijl A, Dahlström U, Rosano G, Lam CSP, Lund LH (2019) Prevalence and prognostic implications of longitudinal ejection fraction change in heart failure. JACC Heart Fail 7(4):306–317 CrossRefPubMed Savarese G, Vedin O, D’Amario D, Uijl A, Dahlström U, Rosano G, Lam CSP, Lund LH (2019) Prevalence and prognostic implications of longitudinal ejection fraction change in heart failure. JACC Heart Fail 7(4):306–317 CrossRefPubMed
15.
Zurück zum Zitat Bansal N, Katz R, Robinson-Cohen C, Odden MC, Dalrymple L, Shlipak MG, Sarnak MJ, Siscovick DS, Zelnick L, Psaty BM, Kestenbaum B, Correa A, Afkarian M, Young B, Boer IH (2017) Absolute rates of heart failure, coronary heart disease, and stroke in chronic kidney disease: an analysis of 3 community-based cohort studies. JAMA Cardiol 2(3):314–318 CrossRefPubMedPubMedCentral Bansal N, Katz R, Robinson-Cohen C, Odden MC, Dalrymple L, Shlipak MG, Sarnak MJ, Siscovick DS, Zelnick L, Psaty BM, Kestenbaum B, Correa A, Afkarian M, Young B, Boer IH (2017) Absolute rates of heart failure, coronary heart disease, and stroke in chronic kidney disease: an analysis of 3 community-based cohort studies. JAMA Cardiol 2(3):314–318 CrossRefPubMedPubMedCentral
16.
Zurück zum Zitat Takahashi Y, Takahasi A, Kuwahara T, Okubo K, Fujino T, Takagi K, Nakashima E, Kamiishi T, Hikita H, Hirao K, Isobe M (2011) Renal function after catheter ablation of atrial fibrillation. Circulation 124(22):2380–2387 CrossRefPubMed Takahashi Y, Takahasi A, Kuwahara T, Okubo K, Fujino T, Takagi K, Nakashima E, Kamiishi T, Hikita H, Hirao K, Isobe M (2011) Renal function after catheter ablation of atrial fibrillation. Circulation 124(22):2380–2387 CrossRefPubMed
17.
Zurück zum Zitat Sato Y, Yamada T, Taniguchi R, Nagai K, Makiyama T, Okada H, Kataoka K, Ito H, Matsumori A, Sasayama S, Takatsu Y (2001) Persistently increased serum concentrations of cardiac troponin t in patients with idiopathic dilated cardiomyopathy are predictive of adverse outcomes. Circulation 103(3):369–374 CrossRefPubMed Sato Y, Yamada T, Taniguchi R, Nagai K, Makiyama T, Okada H, Kataoka K, Ito H, Matsumori A, Sasayama S, Takatsu Y (2001) Persistently increased serum concentrations of cardiac troponin t in patients with idiopathic dilated cardiomyopathy are predictive of adverse outcomes. Circulation 103(3):369–374 CrossRefPubMed
18.
Zurück zum Zitat Baba Y, Kubo T, Yamanaka S, Hirota T, Tanioka K, Yamasaki N, Sugiura T, Kitaoka H (2015) Clinical significance of high-sensitivity cardiac troponin T in patients with dilated cardiomyopathy. Int Heart J 56(3):309–313 CrossRefPubMed Baba Y, Kubo T, Yamanaka S, Hirota T, Tanioka K, Yamasaki N, Sugiura T, Kitaoka H (2015) Clinical significance of high-sensitivity cardiac troponin T in patients with dilated cardiomyopathy. Int Heart J 56(3):309–313 CrossRefPubMed
19.
Zurück zum Zitat Li X, Luo R, Jiang R, Kong H, Tang Y, Shu Y, Hua W (2014) The prognostic use of serum concentration of cardiac troponin-I, CK-MB, and myoglobin in patients with idiopathic dilated cardiomyopathy. Heart Lung 43(3):219–224 CrossRefPubMed Li X, Luo R, Jiang R, Kong H, Tang Y, Shu Y, Hua W (2014) The prognostic use of serum concentration of cardiac troponin-I, CK-MB, and myoglobin in patients with idiopathic dilated cardiomyopathy. Heart Lung 43(3):219–224 CrossRefPubMed
20.
Zurück zum Zitat Eggers KM, Lind L, Ahlstrom H, Bjerner T, Ebeling Barbier C, Larsson A, Venge P, Lindahl B (2008) Prevalence and pathophysiological mechanisms of elevated cardiac troponin I levels in a population-based sample of elderly subjects. Eur Heart J 29(18):2252–2258 CrossRefPubMed Eggers KM, Lind L, Ahlstrom H, Bjerner T, Ebeling Barbier C, Larsson A, Venge P, Lindahl B (2008) Prevalence and pathophysiological mechanisms of elevated cardiac troponin I levels in a population-based sample of elderly subjects. Eur Heart J 29(18):2252–2258 CrossRefPubMed
21.
Zurück zum Zitat Bakshi TK, Choo MKF, Edwards CC, Scott AG, Hart HH, Armstrong GP (2002) Causes of elevated troponin I with a normal coronary angiogram. Intern Med J 32(11):520–525 CrossRefPubMed Bakshi TK, Choo MKF, Edwards CC, Scott AG, Hart HH, Armstrong GP (2002) Causes of elevated troponin I with a normal coronary angiogram. Intern Med J 32(11):520–525 CrossRefPubMed
22.
Zurück zum Zitat Mills NL, Lee KK, McAllister DA, Churchhouse AM, MacLeod M, Stoddart M, Walker S, Denvir MA, Fox KA, Newby DE (2012) Implications of lowering threshold of plasma troponin concentration in diagnosis of myocardial infarction: cohort study. BMJ 344:e1533 CrossRefPubMedPubMedCentral Mills NL, Lee KK, McAllister DA, Churchhouse AM, MacLeod M, Stoddart M, Walker S, Denvir MA, Fox KA, Newby DE (2012) Implications of lowering threshold of plasma troponin concentration in diagnosis of myocardial infarction: cohort study. BMJ 344:e1533 CrossRefPubMedPubMedCentral
Metadaten
Titel
Low troponin I levels predict the presence of arrhythmia-induced cardiomyopathy in patients with atrial fibrillation and left ventricular systolic dysfunction
verfasst von
Daisetsu Aoyama
Shinsuke Miyazaki
Toshihiko Tsuji
Ryohei Nomura
Shota Kakehashi
Moe Mukai
Hiroyuki Ikeda
Kentaro Ishida
Hiroyasu Uzui
Hiroshi Tada
Publikationsdatum
23.02.2023
Verlag
Springer Japan
Erschienen in
Heart and Vessels / Ausgabe 7/2023
Print ISSN: 0910-8327
Elektronische ISSN: 1615-2573
DOI
https://doi.org/10.1007/s00380-023-02242-z

Weitere Artikel der Ausgabe 7/2023

Heart and Vessels 7/2023 Zur Ausgabe

Update Kardiologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.