The annual risk profile for ischemic stroke/bleeding determined by CHA2DS2-VASc/HAS-BLED score and circulating levels of hs-troponin I and NT-proBNP at admission of patients with acutely decompensated heart failure and atrial fibrillation

    Authors

    Keywords

    atrial fibrillation, heart failure, ischemic stroke

    DOI

    https://doi.org/10.15836/ccar2018.348

    Full Text

    Introduction : Atrial fibrillation (AF) is the most common arrhythmia associated with heart failure (HF). ( 1 ) Previous studies have shown correlation of cardiac markers such as NT-proBNP and high-sensitivity Troponin I (hsTnI) with increased risk for thromboembolic and adverse cardiovascular events in patients with AF. ( 2 ) Goals of this study were to evaluate the risk for ischemic stroke (IS) and significant bleeding, to examine clinical and laboratory characteristics, and to determine potential associations of NT-proBNP and hsTnI with aforementioned risks in patients with acute decompensated HF (ADHF) and AF. Patients and Methods : This study included a total of 47 patients with ADHF and AF, diagnosed according to the current criteria of the European Society of Cardiology (ESC)1, which were hospitalized in University Hospital Centre Split during 2018 ( Table 1 ). Patients with an acute coronary syndrome and/or infectious disease were excluded. Results : Mean annual risk for IS without therapy was 8.74% while bleeding risk was 0.60% (p<0.001). After risk adjustment for individual antithrombotic therapy, mean risks for IS and bleeding were 3.46% and 3.10%, respectively, without significant difference between these risks (p=0.430). Use of non-vitamin K oral anticoagulants was almost equated with warfarin use (47.5% vs. 52.5%). Mean levels of hsTnI and NT-proBNP on admission were 56.7 ng/mL and 6550 pg/mL, respectively. Levels of hsTnI above the upper reference limit adjusted by sex were found in 26 (55.3%) patients. Levels of NT-proBNP on admission were significantly higher (p=0.014) in patients with higher risk for IS, as well as levels of hsTnI but without statistical significance (p=0.388). hsTnI showed positive correlation with NT-proBNP (r=0.545, p=0.010) and C-reactive protein (r=0.559, p<0.001), while NT-proBNP exhibited positive correlation with mean annual risk for IS (r=0.587, p=0.002) ( Figure 1 ). Mean NT-proBNP plasma levels (pg/mL) according to the annual risk of stroke or thromboembolic event divided in three categories of risk (<4%, 4-8%, >8%). Conclusion : The antithrombotic management reduced the risk for IS by nearly threefold, with an acceptable bleeding risk. Levels of hsTnI were increased in a large number of patients suggesting that myocardial injury is common during the hospitalization event of ADHF with AF. Levels of NT-proBNP on admission, in presented population, may aid in annual risk stratification for IS and thromboembolic event.

    Cardiologia Croatica
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    The annual risk profile for ischemic stroke/bleeding determined by CHA2DS2-VASc/HAS-BLED score and circulating levels of hs-troponin I and NT-proBNP at admission of patients with acutely decompensated heart failure and atrial fibrillation

    Extended Abstract
    Issue11-12
    Published
    Pages348-349
    PDF via DOIhttps://doi.org/10.15836/ccar2018.348
    atrial fibrillation
    heart failure
    ischemic stroke

    Authors

    Josip Anđelo Borovac*ORCIDUniversity of Split School of Medicine, Split, Croatia
    Joško BožićORCIDUniversity of Split School of Medicine, Split, Croatia
    Zora Sušilović GrabovacORCIDUniversity of Split School of Medicine, Split, Croatia
    Anteo BradarićORCIDUniversity of Split School of Medicine, Split, Croatia
    Andrija MatetićORCIDUniversity of Split School of Medicine, Split, Croatia
    Katarina NovakORCIDUniversity of Split School of Medicine, Split, Croatia
    Duška GlavašORCIDUniversity of Split School of Medicine, Split, Croatia

    Full Text

    Introduction : Atrial fibrillation (AF) is the most common arrhythmia associated with heart failure (HF). ( 1 ) Previous studies have shown correlation of cardiac markers such as NT-proBNP and high-sensitivity Troponin I (hsTnI) with increased risk for thromboembolic and adverse cardiovascular events in patients with AF. ( 2 ) Goals of this study were to evaluate the risk for ischemic stroke (IS) and significant bleeding, to examine clinical and laboratory characteristics, and to determine potential associations of NT-proBNP and hsTnI with aforementioned risks in patients with acute decompensated HF (ADHF) and AF. Patients and Methods : This study included a total of 47 patients with ADHF and AF, diagnosed according to the current criteria of the European Society of Cardiology (ESC)1, which were hospitalized in University Hospital Centre Split during 2018 ( Table 1 ). Patients with an acute coronary syndrome and/or infectious disease were excluded. Results : Mean annual risk for IS without therapy was 8.74% while bleeding risk was 0.60% (p<0.001). After risk adjustment for individual antithrombotic therapy, mean risks for IS and bleeding were 3.46% and 3.10%, respectively, without significant difference between these risks (p=0.430). Use of non-vitamin K oral anticoagulants was almost equated with warfarin use (47.5% vs. 52.5%). Mean levels of hsTnI and NT-proBNP on admission were 56.7 ng/mL and 6550 pg/mL, respectively. Levels of hsTnI above the upper reference limit adjusted by sex were found in 26 (55.3%) patients. Levels of NT-proBNP on admission were significantly higher (p=0.014) in patients with higher risk for IS, as well as levels of hsTnI but without statistical significance (p=0.388). hsTnI showed positive correlation with NT-proBNP (r=0.545, p=0.010) and C-reactive protein (r=0.559, p<0.001), while NT-proBNP exhibited positive correlation with mean annual risk for IS (r=0.587, p=0.002) ( Figure 1 ). Mean NT-proBNP plasma levels (pg/mL) according to the annual risk of stroke or thromboembolic event divided in three categories of risk (<4%, 4-8%, >8%). Conclusion : The antithrombotic management reduced the risk for IS by nearly threefold, with an acceptable bleeding risk. Levels of hsTnI were increased in a large number of patients suggesting that myocardial injury is common during the hospitalization event of ADHF with AF. Levels of NT-proBNP on admission, in presented population, may aid in annual risk stratification for IS and thromboembolic event.