Background
Cardiac biomarkers and left ventricular hypertrophy (
LVH
) are related to the risk of stroke and death in patients with atrial fibrillation. We investigated the interrelationship between
LVH
and cardiac biomarkers and their independent associations with outcomes.
Methods and Results
Plasma samples were obtained at baseline in 5275 patients with atrial fibrillation in the
RE
‐
LY
(Randomized Evaluation of Long‐Term Anticoagulation Therapy) trial.
NT
‐proBNP (N‐terminal pro‐B‐type natriuretic peptide), cardiac troponin I and T, and growth differentiation factor‐15 were determined using high‐sensitivity (hs) assays.
LVH
was defined by
ECG
. Cox models were adjusted for baseline characteristics,
LVH
, and biomarkers.
LVH
was present in 1257 patients. During a median follow‐up of 2.0 years, 165 patients developed a stroke and 370 died.
LVH
was significantly (
P
<0.0001) associated with higher levels of all biomarkers in linear regression analyses adjusting for baseline characteristics. Geometric mean ratios (95% CIs) were as follows:
NT
‐pro
BNP
, 1.32 (1.25–1.38); hs cardiac troponin I, 1.67 (1.57–1.78); hs troponin T, 1.38 (1.32–1.44); and growth differentiation factor‐15, 1.09 (1.05–1.12). For stroke, the hazard ratios (95% CIs) per 50% increase were as follows:
NT
‐pro
BNP,
1.09 (1.00–1.19); hs cardiac troponin I, 1.09 (1.03–1.15); hs troponin T, 1.14 (1.06–1.24); and growth differentiation factor‐15, 1.22 (1.08–1.38) (all
P
<0.05). For death, hazard ratios (95% CIs) were as follows:
NT
‐pro
BNP
, 1.24 (1.17–1.31); hs cardiac troponin I, 1.13 (1.10–1.17); hs troponin T, 1.28 (1.23–1.34); and growth differentiation factor‐15, 1.31 (1.22–1.42) (all
P
<0.0001).
LVH
was not significantly associated with stroke or death after adjustment for biomarkers.
Conclusions
Cardiac biomarkers are significantly associated with
LVH
. The prognostic value of biomarkers for stroke and death is not affected by
LVH
. The prognostic information of
LVH
is attenuated in the presence of cardiac biomarkers.
Clinical Trial Registration
URL
:
http://www.clinicaltrials.gov
. Unique identifier:
NCT
00262600.