title: High-sensitivity cardiac troponin T and the risk of incident atrial fibrillation: the Atherosclerosis Risk in Communities (ARIC) study.
abstract: BACKGROUND
  Structural changes in the heart are known risk factors for atrial fibrillation (AF). An association between high-sensitivity cardiac troponin T (hs-cTnT), a marker of myocardial cell damage measured with a high-sensitivity assay, and the risk of AF could have implications for AF risk stratification.
  
  
  OBJECTIVE
  To estimate the association between hs-cTnT and the risk of incident AF in the ARIC study, a prospective cohort of middle-aged adults from 4 US communities.
  
  
  METHODS
  Study included 10,584 participants (mean age 62.7 years) free of AF in 1996 to 1998 and followed through 2008. Atrial fibrillation was defined using International Classification of Diseases codes from hospitalizations and death certificates. Participants with undetectable hs-cTnT levels (58%) were assigned the lower limit of measurement (5 ng/L). Net reclassification improvement was used to examine the discriminative ability of hs-cTnT for 10-year AF risk prediction (categories: <5%, 5%-15%, and >15%).
  
  
  RESULTS
  A total of 920 incident AF cases were observed for 109,227 person-years. After adjustment, a 1-SD difference in ln(hs-cTnT) was associated with a hazard ratio of 1.16 (95% CI 1.10-1.23). Compared with those with undetectable levels, participants with hs-cTnT ≥14 ng/L had a hazard ratio of 1.78 (95% CI 1.43-2.24). Addition of hs-cTnT to known AF predictors did not increase the c statistic appreciably (0.756 vs 0.758) or improve risk stratification (net reclassification improvement 0.4%, 95% CI -1.4% to 2.3%).
  
  
  CONCLUSIONS
  High-sensitivity cTnT level is associated with an increased incidence rate of AF but did not improve risk stratification.
authors.affiliation: Division of Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, McGill University, Montreal, Quebec, Canada; Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN. Electronic address: kristian.filion@mcgill.ca.
authors.forename: Kristian B
authors.initials: KB
authors.lastname: Filion
authors.affiliation: Departments of Medicine and Epidemiology, Johns Hopkins University, Baltimore, MD.
authors.forename: Sunil K
authors.initials: SK
authors.lastname: Agarwal
authors.affiliation: Center for Cardiovascular Disease Prevention, Methodist DeBakey Heart and Vascular Center, Houston, TX; Section of Cardiovascular Research, Division of Atherosclerosis and Vascular Medicine, Baylor College of Medicine, Houston, TX.
authors.forename: Christie M
authors.initials: CM
authors.lastname: Ballantyne
authors.affiliation: Division of Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, McGill University, Montreal, Quebec, Canada.
authors.forename: Maria
authors.initials: M
authors.lastname: Eberg
authors.affiliation: Center for Cardiovascular Disease Prevention, Methodist DeBakey Heart and Vascular Center, Houston, TX; Section of Cardiovascular Research, Division of Atherosclerosis and Vascular Medicine, Baylor College of Medicine, Houston, TX.
authors.forename: Ron C
authors.initials: RC
authors.lastname: Hoogeveen
authors.affiliation: School of Population Health, The University of Queensland, Brisbane, Australia.
authors.forename: Rachel R
authors.initials: RR
authors.lastname: Huxley
authors.affiliation: Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC.
authors.forename: Laura R
authors.initials: LR
authors.lastname: Loehr
authors.affiliation: Center for Cardiovascular Disease Prevention, Methodist DeBakey Heart and Vascular Center, Houston, TX; Section of Cardiovascular Research, Division of Atherosclerosis and Vascular Medicine, Baylor College of Medicine, Houston, TX; Michael E. DeBakey Veterans Affairs Hospital, Houston, TX.
authors.forename: Vijay
authors.initials: V
authors.lastname: Nambi
authors.affiliation: Epidemiological Cardiology Research Center (EPICARE), Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston Salem, NC.
authors.forename: Elsayed Z
authors.initials: EZ
authors.lastname: Soliman
authors.affiliation: Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN.
authors.forename: Alvaro
authors.initials: A
authors.lastname: Alonso
mesh_terms: D000368:Aged; D050197:Atherosclerosis / Q000097:blood; D001281:Atrial Fibrillation / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment; D012307:Risk Factors; D020107:Troponin T / Q000097:blood*
chemical_list: D020107:Troponin T