Do We Need to Measure Troponin in Hospitalized Patients with Atrial Fibrillation with Rapid Ventricular Rate (AF/RVR)?

1Cooper University Hospital, Camden, NJ
2Cooper University Hospital, Camden, NJ
3Cooper University Hospital, Camden, NJ
4Cooper University Hospital, Camden, NJ

Meeting: Hospital Medicine 2010, April 8-11, Washington, D.C.

Abstract number: 390

Background:

It is a common practice to measure troponin in hospitalized patients with AF/RVR. Tachyarrhythmia has been associated with leakage of troponins. Minor troponin leak with AF/RVR with chronic kidney disease (CKD) and congestive heart failure (CHF) has been reported in literature. Significance of minor troponin leaks with AF/RVR in these patients is not well studied.

Methods:

We conducted a retrospective review of patients admitted to a university hospital between 2003 and 2003 after IRB approval. We identified the patients who had AF with RVR during hospitalization. Inclusion criteria were patients with AF with sustained RVR more than 100. We excluded patients with history of coronary artery disease (CAD). CHF, CKD with creatinine > 1.4 mg/dL, and intracardiac defibrillator firing or recent cardioversion. All patients had troponin level measured At 0 and 6 hours.

Results:

We identified 1435 patient based on the inclusion criteria. We excluded 1158 patient based on our exclusion criteria. Only 277 patients met both the criteria. Thirty‐two patients had troponin leak in the first 6 hours. These 32 patients had normal coronary angiogram or stress test (see Table 1).

Discussion:

Cardiac troponins are sensitive biomarkers for many clinical syndromes indicating myocyte injury and necrosis. It has been hypothesized that tachyarrhythmia can cause minor troponin leak because eof shortening of diastole with subendocardial ischemia or myocardial stretch. Our study showed 11.5% patients with troponin leak compared to 56% in prior study. Increasing age and heart rate were risk factors for troponin leak with AF/RVR with normal creatinine without CAD and CHF. The mechanism and clinical implications of troponin leak in these patients is not well understood. Definitive treatment of AF can get delayed because of unnecessary workup for myocardial ischemia. We need better understanding of this highly sensitive troponin leak in patients with AF/RVR

Conclusions:

There is an overestimation of troponin leak in patients with AF/RV wilhout known CHF, CKD and CAD. Advanced age and increased heart rate may be contributing factors for troponin leak. Routine evaluation for myocardial ischemia without other risk factors in these patients may not be necessary.

Author Disclosure:

L. Zhang, none; G. Shastri, none: K. Hunter, none; V. Rajput, none.

To cite this abstract:

Zhang L, Shastri G, Hunter K, Rajput V. Do We Need to Measure Troponin in Hospitalized Patients with Atrial Fibrillation with Rapid Ventricular Rate (AF/RVR)?. Abstract published at Hospital Medicine 2010, April 8-11, Washington, D.C. Abstract 390. Journal of Hospital Medicine. 2010; 5 (suppl 1). https://www.shmabstracts.com/abstract/do-we-need-to-measure-troponin-in-hospitalized-patients-with-atrial-fibrillation-with-rapid-ventricular-rate-afrvr/. Accessed July 15, 2019.

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