Authors

• Josip Anđelo Borovac — Medicinski fakultet Sveučilišta u Splitu, Split, Hrvatska — ORCID: 0000-0002-4878-8146
• Joško Božić — Medicinski fakultet Sveučilišta u Splitu, Split, Hrvatska — ORCID: 0000-0003-1634-0635
• Zora Sušilović Grabovac — Klinički bolnički centar Split, Split, Hrvatska — ORCID: 0000-0001-9999-7557
• Anteo Bradarić — Medicinski fakultet Sveučilišta u Splitu, Split, Hrvatska — ORCID: 0000-0002-9843-6309
• Andrija Matetić — Medicinski fakultet Sveučilišta u Splitu, Split, Hrvatska — ORCID: 0000-0001-9272-6906
• Katarina Novak — Medicinski fakultet Sveučilišta u Splitu, Split, Hrvatska — ORCID: 0000-0002-7174-0722
• Duška Glavaš — Medicinski fakultet Sveučilišta u Splitu, Split, Hrvatska — ORCID: 0000-0003-2649-0936

Abstract

**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. ### TABLE 1: Baseline characteristics of heart failure patients with atrial fibrillation. | **Variable** | **Mean ± SD or N(%)** **or Median (IQR)** | **Variable** | **Mean ± SD or N(%) or Median (IQR)** | | --- | --- | --- | --- | | Age (years) | 73.3 ± 9.9 | LAVI (mL/m2) | 41.3 ± 15.7 | | BMI (kg/m2) | 30.1 ± 4.1 | Hemoglobin (g/L) | 142 ± 17 | | Male sex | 32 (68.1%) | PT-INR | 3.2 ± 2.4 | | Positive history of a prior ACS event | 18 (38.3%) | APTT (s) | 30.6 ± 13.4 | | Prior stroke, TIA or thromboembolism | 7 (14.9%) | NT-proBNP at index admission (pg/mL) | 6550 ± 3381 | | Prior CABG | 8 (17.0%) | hs-cTnI at index admission (ng/mL) | 56.7 ± 40.6 | | Arterial hypertension | 42 (89.4%) | CRP at index admission (mg/L) | 27.3 ± 29.2 | | Dyslipidemia | 27 (57.4%) | Mean HR at admission (bpm) | 100 ± 27 | | Diabetes mellitus | 16 (34.0%) | Mean QRS duration (msec) | 115 ± 33 | | Smoking (ex or current) | 13 (26.5%) | Mean QTc (msec) | 433 ± 47 | | PAD | 12 (25.5%) | Prolonged QT interval | 17 (36.2%) | | Vascular disease (PAD, AMI, aortic plaque) | 27 (57.4%) | Oral anticoagulants | 40 (85.1%) | | CHA2DS2-VASc score | 5 (4-5) | Warfarin | 21/40 (52.5%) | | 0-4% stroke or thromboembolism risk | 17 (36.2%) | NOAC | 19/40 (47.5%) | | 4-8% stroke or thromboembolism risk | 16 (34.0%) | Antiplatelet agent | 10 (21.3%) | | >8% stroke or thromboembolism risk | 14 (29.8%) | ACE inhibitor or ARB | 38 (80.9%) | | HAS-BLED score | 2 (1-2) | Beta-blocker | 38 (80.9%) | | NYHA functional class | 3 (2-4) | Loop and/or thiazide and/or thiazide-like diuretics | 39 (82.9%) | | SBP (mmHg) | 132 ± 20 | ARNi | 8 (17.0%) | | DBP (mmHg) | 81 ± 11 | Mineralocorticoid antagonist | 14 (29.8%) | | eGFR (mL/min/1.73 m2) | 57.1 ± 22.5 | Calcium channel blocker | 10 (21.3%) | | LVEF (%) | 37 ± 14 | Digoxin | 15 (31.9%) | | LA diameter (mm) | 52 ± 10 | Statin | 18 (38.3%) | | LA volume (mL) | 72 ± 31 | Allopurinol | 7 (14.9%) | [†] **Abbreviations: ACE**-angiotensin-converting enzyme; **ACS**-acute coronary syndrome; **AMI**-acute myocardial infarction; **APTT**-activated partial thromboplastin time; **ARB**-angiotensin II receptor blocker, **ARNi**-angiotensin receptor-neprilysin inhibitor; **BMI**-body mass index, **CABG**-coronary artery bypass grafting; **CRP**-C-reactive protein; **DBP**-diastolic blood pressure; **eGFR**-estimated glomerular filtration rate; **HR**-heart rate; **hs-cTnI**-high-sensitivity cardiac troponin I; **LA**-left atrium; **LAVI**-left atrial volume indexed by body surface; **NT-proBNP**-N-terminal prohormone of brain natriuretic peptide; **NYHA**-New York Heart Association functional classification of heart failure; **PAD**-peripheral artery disease; **PT-INR**-prothrombin time international standardized ratio; **SBP**-systolic blood pressure; **TIA**-transient ischemic attack. **Results**: Mean annual risk for IS without therapy was 8.74% while bleeding risk was 0.60% (p8%). **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.

Keywords

atrial fibrillation, heart failure, ischemic stroke

DOI

Literature

1. Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JG, Coats AJ, et al. Authors/Task Force Members; Document Reviewers. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail. 2016 Aug;18(8):891–975. https://doi.org/10.1002/ejhf.592
2. Hijazi Z, Oldgren J, Siegbahn A, Granger CB, Wallentin L. Biomarkers in atrial fibrillation: a clinical review. Eur Heart J. 2013 May;34(20):1475–80. https://doi.org/10.1093/eurheartj/eht024