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Persistently high cardiac biomarkers important in AF

Persistent elevation of troponin and the N-terminal prohormone of brain natriuretic peptide (NT-proBNP) indicates a worse prognosis than transient elevations or no elevations of either marker, according to a study published recently in Heart.1

Plasma samples were obtained at randomisation and after 3 months in 2,514 patients with atrial fibrillation (AF) in the RE-LY (Randomized Evaluation of Long-Term Anticoagulation Therapy) trial; median follow-up was 2.0 years. Patients were grouped based on levels at the two time points according to detectable cTnI levels (≥0.01 µg/L) or NT-proBNP levels above median (≥778 ng/L). These groups were related to occurrence of stroke or cardiovascular events evaluated with Cox models adjusting for established risk factors.

The proportion of patients with detectable cTnI levels at both time points was 48.5%, at one time point 28.5% and at neither time point 21.0%. Patients with detectable cTnI at both time points had substantially higher rates of stroke compared with those with transient elevations and those with no elevation at either time point (p<0.005, effect of cTnI).

Persistent elevation of either or both cardiac biomarkers at baseline and 3 months was associated with a higher risk for cardiovascular events and mortality (p<0.0001). Prognostic prediction improved most with the use of repeated measurements of both cardiac biomarkers simultaneously (p<0.05) and achieved C-statistic 0.644 for stroke compared with 0.611 for CHADS2-score.


1. Hijazi Z, Oldgren J, Andersson U, et al. Importance of persistent elevation of cardiac biomarkers in atrial fibrillation: a RE-LY substudy. Heart 2014;100:1193–200.

Published on: August 5, 2014

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  • ArrhythmiaAlliance
  • Stars
  • Anticoagulation Europe
  • Atrial Fibrillation Association

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