Duration of atrial fibrillation and cardiac biomarkers are associated with cardiovascular outcomes in early permanent atrial fibrillation: Data from the RACE II study

INTRODUCTION: Atrial fibrillation (AF) is a progressive disease and is associated with considerable cardiovascular morbidity and mortality. This post-hoc analysis of the RACE II study aimed to identify parameters associated with cardiovascular morbidity and mortality in early permanent AF. METHODS AND RESULTS: Out of the 614 patients included in RACE II, 543 had biomarkers available at baseline and were included in the present analyses. The mean age was 68 ± 8 years and 34 % were women. Median AF duration was 18 months and median duration since progression into permanent AF was 3 months. Coronary artery disease was present in 101 (19 %) patients and 54 (10 %) patients had a history of hospitalization due to heart failure. Plasma concentrations of high sensitive troponin T (hs-TnT) and N-terminal pro B-type natriuretic peptide (NT-proBNP) were 9 pg/ml (interquartile range 7-14) and 1003 pg/ml (interquartile range 634-1632), respectively. The primary endpoint was a composite of cardiovascular death, hospitalization for heart failure, stroke, systemic embolism, major bleeding, and severe arrhythmic events. After a follow-up of 3 years, a total of 67 (12.0 %) patients reached the primary composite outcome. After multivariable adjustment, a longer duration since the first episode of AF (hazard ratio 1.07 (95 % CI 1.02-1.12), P = 0.008) and elevated levels of hs-TnT (hazard ratio 1.64 (95 % CI 1.25-2.15), p < 0.001) were associated with the primary outcome CONCLUSION: In early permanent AF patients, a longer duration since the first episode of AF and a higher level of blood biomarker hs-TnT are independent determinants for cardiovascular morbidity and mortality.