Structural Cardiac Abnormalities in Patients with Atrial Fib
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A retrospective observational cohort study of patients with atrial fibrillation/flutter diagnosis with hs-cTnT measurements, echocardiograms, and coronary angiograms. Myocardial injury was defined as hs-cTnT >10 ng/L for women and >15 ng/L for men. Cases with myocardial injury were adjudicated according to the Fourth Universal Definition of Myocardial Infarction. Patients with definite causes for increased hs-cTnT (n=875) were tabulated but not evaluated further; common diagnoses were typed 1 myocardial infarction, critical illness, and known heart failure. Of the remaining 401, increased hs-cTnT was present in 336 (84%) patients. Of those, 78% had a non-ischemic myocardial injury, and the remaining (n=75, 22%) type 2 myocardial infarction. Patients with elevated hs-cTnT had a greater left ventricular mass index, left ventricular filling pressures, and right ventricular systolic pressure. The more frequently had significant coronary artery disease (47% vs 31%, p=0.016), especially in type 2 myocardial infarction. With logistic regression, age, sex (F), diabetes, left ventricular mass index, e’ medial velocity, and right ventricular systolic pressure were independent determinants of myocardial injury. One-year mortality was higher in patients with myocardial injury. Structural heart abnormalities are common in patients with atrial fibrillation/flutter and increased hs-cTnT. Causes of myocardial injury should be elucidated in each patient to craft appropriate therapies.