Key result
Rate-controlling drugs lower resting and peak exercise hs-TnI levels from baseline.
Why the study?
Do rate control drugs (diltiazem, verapamil, metoprolol, carvedilol) reduce hs-TnI levels at rest and during exercise in patients with stable permanent atrial fibrillation?
RCT (n=60)
Single-blind
computer-generated block randomisation list
Do rate control drugs (diltiazem, verapamil, metoprolol, carvedilol) reduce hs-TnI levels at rest and during exercise in patients with stable permanent atrial fibrillation?
p-value: p=<0.001
Rate control therapy with beta-blockers or calcium channel blockers significantly reduces hs-TnI levels at rest and during exercise in patients with permanent atrial fibrillation.
Rate control may reduce subclinical myocardial injury in permanent AF; extends evidence for these agents beyond symptom or rate management alone.
BACKGROUND: High-sensitivity troponin I (hs-TnI) and troponin T (hs-TnT) are moderately correlated and independently related to outcome in atrial fibrillation (AF). Rate controlling therapy has been shown to reduce hs-TnT, however the potential impact on hs-TnI levels, and whether this differs from the effects on hs-TnT, has not been investigated previously. METHODS: Sixty patients with stable, permanent AF without heart failure or known ischemic heart disease were included in a randomised crossover study (mean age 71 ± 9 years, 18 women). Diltiazem 360 mg, verapamil 240 mg, metoprolol 100 mg, and carvedilol 25 mg were administered once daily for three weeks, in a randomised sequence. At baseline and on the last day of each treatment period, hs-TnI was measured at rest and after a maximal exercise test and compared to hs-TnT. RESULTS: Hs-TnI and hs-TnT correlated moderately at baseline (rs = 0.582, p < 0.001). All drugs reduced both the resting and the peak exercise levels of hs-TnI compared with baseline (p < 0.001 for all). The decline in resting hs-TnI and hs-TnT values relative to baseline levels was similar for all drugs except for verapamil, which reduced hs-TnI more than hs-TnT (p = 0.017). Levels of hs-TnI increased significantly in response to exercise testing at baseline and at all treatment regimens (p < 0.001 for all). The relative exercise-induced increase in hs-TnI was significantly larger compared to hs-TnT at baseline (p < 0.001), on diltiazem (p < 0.001) and on verapamil (p = 0.001). CONCLUSIONS: In our population of stable, permanent AF patients, all four rate control drug regimens reduced hs-TnI significantly, both at rest and during exercise. The decline in hs-TnI and hs-TnT levels associated with beta-blocker and calcium channel blocker treatment was similar, except for a larger relative decrease in hs-TnI levels following verapamil treatment. TRIAL REGISTRATION: www.clinicaltrials.gov ( NCT00313157 ).
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Horjen et al. (2016) conducted an RCT in stable, permanent atrial fibrillation (n=60). Diltiazem, verapamil, metoprolol, and carvedilol vs. Baseline (no treatment) was evaluated on High-sensitivity troponin I (hs-TnI) levels at rest and after a maximal exercise test (p=<0.001). All four rate-controlling drugs (diltiazem, verapamil, metoprolol, carvedilol) significantly reduced resting and peak exercise levels of high-sensitivity troponin I compared to baseline (p<0.001 for all).
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