Rethinking rate-related myocardial injury in sepsis: atrial fibrillation, heart rate, cardiac troponin T and long-term mortality.

Authors

Samantha Lörstad, Louise Essehorn, Johan Engdahl, Jonas Persson

Published in

Open heart. Volume 13. Issue 1. Jun 22, 2026. Epub Jun 22, 2026.

Abstract

Atrial fibrillation (AF), elevated heart rate and elevated high-sensitivity cardiac troponin T (hs-cTnT) are common in sepsis, but their independent and combined prognostic significance remains uncertain.
This secondary analysis of the retrospective Sepsis and Elevated Troponin cohort study included adults with sepsis requiring vasopressor support admitted to critical care units at Danderyd University Hospital, Stockholm, Sweden, between March 2012 and September 2021. Eligible patients fulfilled Sepsis-3 criteria and had hs-cTnT measured within 48 hours of sepsis onset. Patients were classified as having no AF, pre-existing AF or new-onset AF. AF status and highest recorded heart rate during the first 72 hours were examined in relation to troponin concentrations and 1-year mortality using linear regression, Kaplan-Meier analysis and multivariable Cox proportional hazards regression.
Among 586 included patients, 177 (30%) had pre-existing AF and 112 (19%) developed new-onset AF. Elevated hs-cTnT (≥15 ng/L) was present in 546 patients (93%). Patients with AF had higher hs-cTnT concentrations and higher recorded heart rates. AF accounted for only 1.2% of the variability in hs-cTnT concentrations and 2.2% of the variability in highest recorded heart rate. Heart rate was not associated with hs-cTnT concentrations or mortality. One-year mortality was higher in patients with pre-existing AF (HR 2.4, 95% CI 1.8-3.2) and new-onset AF (HR 1.8, 95% CI 1.3-2.5) than in those without AF. One-year mortality increased progressively across hs-cTnT quartiles, with an additive increase in risk among patients with concomitant AF. After multivariable adjustment, AF and hs-cTnT concentrations remained independently associated with 1-year mortality, whereas highest recorded heart rate did not.
In adults with sepsis requiring vasopressor support, AF and elevated hs-cTnT were associated with increased 1-year mortality, with additive prognostic value independent of highest recorded heart rate. Concomitant AF and troponin elevation identify a high-risk subgroup of sepsis patients whose myocardial injury should not be attributed solely to rate-related demand ischaemia.

PMID:
42331569
Bibliographic data and abstract were imported from PubMed on 23 Jun 2026.

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