Valvular heart disease
Prognostic Usefulness of Circulating High-Sensitivity Troponin T in Aortic Stenosis and Relation to Echocardiographic Indexes of Cardiac Function and Anatomy

https://doi.org/10.1016/j.amjcard.2011.02.346Get rights and content

The new high-sensitivity cardiac troponin T (hs-cTnT) assay seems to provide important prognostic information in patients with stable cardiovascular disease. To understand the merit of hs-cTnT more closely in stable cardiovascular disease, we performed extensive echocardiographic characterization of 57 patients with aortic stenosis and myocardial hypertrophy and related hs-cTnT levels to prognosis and echocardiographic indexes of myocardial structure and function. The hs-cTnT levels were above the assay's detection limit in all patients, correlated with echocardiographic indexes of structure and function, most notably with left ventricular mass, and demonstrated prognostic utility of similar strength as N-terminal pro–B-type natriuretic peptide. In conclusion, these findings indicate that hs-cTnT may provide prognostic information in patients with aortic stenosis, and that left ventricular mass is an important determinant of TnT levels in stable patients as measured by the new highly sensitive assay.

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Methods

Fifty-seven patients referred to a cardiothoracic center (Oslo University Hospital, Rikshospitalet, Oslo, Norway) for presurgical evaluation were consecutively included in the study. All patients had a diagnosis of moderate to severe AS. A complete echocardiographic study was performed per standard views and guidelines6 by Vivid 7 (GE Vingmed, Horten, Norway). Images were stored in Echopac (GE Vingmed) and later processed and evaluated by an experienced researcher (T.E.) blinded to biomarker

Results

Patient characteristics are presented in Table 1. Patients were elderly, had slightly impaired renal function, and were clinical stable. A large proportion of patients had significant co-morbidities. Echocardiography confirmed the diagnosis of AS in all patients, and most patients had evidence of moderate to severe AS with myocardial hypertrophy but with relatively preserved left atrial and ventricular dimensions (Table 2). Furthermore, patients exhibited evidence of diastolic dysfunction, and

Discussion

The main results of this study are that (1) TnT levels are universally detectable by the new highly sensitive assay in patients with moderate and severe AS, (2) LV mass and systolic function, expressed as fractional shortening, are independent determinants of hs-cTnT levels in patients with AS, and (3) high hs-cTnT levels are associated with a poor prognosis in AS.

The increased diagnostic and prognostic accuracy of the hs-cTnT assay versus the established cTnT assay has recently been reported

Acknowledgment

We acknowledge the contribution by Lillian Lundeby, BSc, Oslo University Hospital, Rikshospitalet, to the collection of blood samples and data collection. We are also grateful to the physicians and technicians at the Department of Cardiology, Oslo University Hospital, Rikshospitalet, who contributed to the echocardiographic and angiographic examinations, and Siri Mortensen, BSc, and Line Bugge Klem Steffarud, BSc, at the Center of Laboratory Medicine, Akershus University Hospital for skillful

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This study was supported by the University of Oslo, Oslo, Norway. Dr. Omland has received lecture fees and grant support from Roche Diagnostics, Basel, Switzerland.

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