Relation Between Soluble ST2, Growth Differentiation Factor–15, and High-Sensitivity Troponin I and Incident Atrial Fibrillation

Study Questions:

Are soluble ST2, growth differentiation factor–15 (GDF-15), and high-sensitivity troponin I (hs-TnI) associated with incident atrial fibrillation (AF), and do these biomarkers improve current risk prediction models for AF?


The authors investigated the relationship between soluble ST2, GDF-15, and hs-TnI, and the development of AF in Framingham Heart Study participants without prevalent AF. A Cox proportional hazard regression analysis was used to determine whether there is an association between each biomarker and incident AF during a 10-year follow-up period. In addition to controlling for the standard AF clinical risk factors, the authors also adjusted for more conventional biomarkers such as B-type natriuretic peptide (BNP), and C-reactive protein (CRP).


AF was diagnosed in 242 of the 3,217 participants (8%) during the follow-up period. In age- and sex-adjusted models, GDF-15 and hs-TnI were associated with AF. However, after controlling for the clinical risk factors, and BNP and CRP, only hs-TnI was found to be associated with AF (hazard ratio, 1.12; 95% confidence interval, 1.00-1.26; p = 0.045). The c statistic of the base model including clinical risk factors, BNP, and CRP was 0.803, and did not improve by adding individual or all three biomarkers in question.


The authors concluded that hs-TnI was associated with incident AF. The proposed biomarkers did not improve AF risk discrimination.


Troponin I was modestly associated with development of AF in this post-hoc analysis using the Framingham data set. However, neither its inclusion nor that of the other novel biomarkers was additive to the base model, which consisted of clinical AF risk factors and the conventional biomarkers. It might be interesting to see if inclusion of any biomarker would be incremental to a model consisting only of the clinical characteristics included in this study and obstructive sleep apnea, which was not.

Clinical Topics: Sleep Apnea

Keywords: C-Reactive Protein, Follow-Up Studies, Troponin I, Growth Differentiation Factor 15, Risk Factors, Sleep Apnea, Obstructive, Natriuretic Peptide, Brain

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