Elsevier

Journal of Cardiac Failure

Volume 16, Issue 12, December 2010, Pages 950-956
Journal of Cardiac Failure

Clinical Investigation
Serum Levels of High-Sensitivity Troponin T: A Novel Marker for Cardiac Remodeling in Hypertrophic Cardiomyopathy

https://doi.org/10.1016/j.cardfail.2010.07.245Get rights and content

Abstract

Background

Hypertrophic cardiomyopathy (HCM) is characterized by inappropriate hypertrophy, small-vessel coronary artery disease, myocyte disarray, and increased interstitial fibrosis. High-sensitivity troponin T (hs-TnT) could be a reliable indicator of myocardial remodeling, a proposed prognostic marker in HCM. Therefore we hypothesized that increased hs-TnT levels are related to different variables associated with myocardial remodeling, such as the presence of fibrosis assessed with cardiac magnetic resonance imaging (MRI).

Methods and Results

We included 95 hemodynamically stable HCM patients, 72 male, aged 45.7 ± 14.2 years, and 45 healthy control subjects with similar age and gender. A complete history and clinical examination was performed, including 12-lead electrocardiogram (ECG), echocardiography, 24-hour ECG-Holter monitoring, symptom-limited treadmill exercise test, and late gadolinium enhancement in cardiac MRI. Risk factors for sudden death were evaluated. A blinded cardiac MRI was performed with late gadolinium enhancement study. Serum hs-TnT levels were assayed. A high proportion (42%) of hemodynamically stable patients studied showed increased levels of hs-TnT. The hs-TnT levels were raised in patients with severe dyspnea: New York Heart Association (NYHA) functional class ≥3 (P = .020), outflow obstruction (P = .013), systolic dysfunction (P = .037), abnormal blood pressure response (P = .036), and presence of gadolinium enhancement (P = .021). The hs-TnT levels correlated positively with the maximum left ventricular wall thickness (r = 0.47; P < .001), left atrial diameter (r = 0.36, P = .014), and outflow gradient (r = 0.28; P = .008).

Conclusions

A high proportion of hemodynamically stable patients show increased levels of hs-TnT. We observed that raised hs-TnT serum levels are associated with different conditions related to the severity of the disease.

Section snippets

Patients and Methods

We included 95 HCM stable patients attending a cardiology outpatient clinic for routine follow-up, from two referral hospitals in Spain (Hospital Universitario Virgen de la Arrixaca, Murcia, and Hospital General Universitario, Alicante), aged 45.7 ± 14.2 years old and 72 (75.8%) of them male. The criteria for diagnosis of HCM was the presence of a LV wall thickness of ≥15 mm without any other cause that could lead to ventricular hypertrophy, and in the case of first-degree relatives of affected

Results

Clinical data of patients are presented in Table 1. Fifty-three patients (55.7%) showed impaired functional class (NYHA ≥II), and only six patients presented systolic dysfunction (6.3%). Forty-three patients (45%) presented angina, and sixty-nine patients (72.6%) showed late gadolinium enhancement assessed by cardiac MRI.

Discussion

This study showed that hs-TnT serum levels were elevated in up to 42% of our cohort of patients with HCM, and in only 4.4% of healthy paired control subjects. Importantly, the HCM patients were stable patients attending to routine follow-up in our referral outpatient clinics. This elevation may reflect a continuous myocyte loss due to a moderate range of necrosis, and it is associated with parameters of HCM severity as the functional class, systolic dysfunction, and fibrosis assessed by cardiac

Disclosures

None.

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    Funding: Supported by an FIS PS09/00721 project for the Instituto de Salud Carlos III, and in part by Funding FEDER and by Roche Diagnostics. Dr Hernández-Romero holds a postdoctoral position funded by the Instituto de Salud Carlos III.

    See page 955 for disclosure information.

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