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Minor troponin T elevation in patients 6 months after acute myocardial infarction: an observational study
Mirja Neizel1, Henning Steen, Grigorios Korosoglou
1Medical Clinic III, University Hospital Heidelberg, Heidelberg, Germany. m.neizel@gmx.de
Insights
Elevated cardiac troponin T (cTnT) is common 6 months after acute myocardial infarction (AMI). This elevation correlates with heart failure indicators, impaired ejection fraction, and higher NT-proBNP levels, suggesting myocardial dysfunction.
Area of Science:
- Cardiology
- Biomarkers
- Cardiac Imaging
Background:
- Troponin elevation in stable coronary heart disease patients indicates adverse outcomes, but mechanisms remain unclear.
- Assessing cardiac troponin T (cTnT) prevalence post-acute myocardial infarction (AMI) is crucial for understanding prognosis.
- Investigating associations between minor cTnT elevation and clinical factors is essential.
Purpose of the Study:
- To determine the prevalence and range of cTnT in stable patients 6 months after AMI using a sensitive assay.
- To explore the relationship between minor cTnT elevation and clinical variables, NT-proBNP, and cardiac MRI findings.
Main Methods:
- Measured cTnT in 98 patients 6 months post-AMI using a high-sensitivity electrochemiluminescence assay.
- Correlated cTnT values with clinical, angiographic, NT-proBNP, and cardiac MRI data.
Main Results:
- Detectable cTnT was found in 90% of patients; 16% exceeded the 99th percentile (>12 ng/L).
- Elevated cTnT correlated with older age, hypertension, higher NYHA class, and diuretic use.
- Patients with cTnT elevation showed impaired left ventricular ejection fraction but not increased infarct size.
Conclusions:
- Minor cTnT elevations are frequent 6 months post-AMI.
- Increased cTnT levels are linked to heart failure parameters, reduced ejection fraction, and elevated NT-proBNP.
- Myocardial dysfunction appears to be the primary driver of cTnT elevation in this patient cohort.
Background:
Troponin elevation in patients with stable coronary heart disease is associated with adverse outcome and prognosis. However, the mechanism is not yet clearly understood. Our objectives were to examine the prevalence and range of cardiac troponin T (cTnT) in stable patients, 6 months after acute myocardial infarction (AMI) using a new high sensitive cTnT assay and to investigate the association of minor cTnT elevation in these patients to clinical variables, NT-proBNP and cardiac MRI-findings.
Study Design And Methods:
cTnT was measured in 98 patients 6 months after AMI with a precommercial assay by electrochemiluminescence methods (Roche Diagnostics, Mannheim, Germany). cTnT values were correlated with clinical and angiographic variables, NT-proBNP concentrations and with cardiac MRI-findings.
Results:
Minor cTnT concentrations were detectable in 90% of the entire cohort, of whom 16% had cTnT values above the 99th percentile (>12 ng/L). These patients were also significantly older, suffered more frequently from hypertension, had a higher New York Heart Association class and received more often diuretics at follow up. Patients with cTnT elevation had a more impaired left ventricular ejection fraction (P = 0.02) but did not have an increased infarct size (P = 0.73).
Conclusions:
Elevated minor cTnT levels are frequently detectable in patients 6 months after AMI. Increased cTnT level were associated with clinical parameter for heart failure, impaired ejection fraction and higher NT-proBNP levels suggesting that myocardial dysfunction is a main cause for cTnT elevation in these patient group.
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