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Published on: August 28, 2018
Combined Assessment of High-Sensitivity Troponin T and Noninvasive Coronary Plaque Composition for the Prediction of
Gitsios Gitsioudis1, Alena Schüssler1, Eszter Nagy1
1From the Department of Cardiology (G.G., A.S., E.N., S.J.B., N.H., E.G., H.A.K., G.K.), Institute of Psychology (A.V.), and Department of Diagnostic and Interventional Radiology (W.H., H.U.K.), University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany; and MTA-SE Lendület Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary (E.N., P.M.H.).
Insights
Cardiac CT angiography and high-sensitivity troponin T (hsTnT) significantly improve cardiovascular event prediction in intermediate-risk patients. Combining plaque burden and hsTnT identifies individuals with the highest risk, enabling personalized management strategies.
Area of Science:
- Cardiology
- Medical Imaging
- Biomarkers
Background:
- Coronary artery disease (CAD) risk stratification in intermediate-risk patients remains challenging.
- Accurate assessment of atherosclerotic burden and myocardial injury is crucial for predicting cardiovascular events.
Purpose of the Study:
- To evaluate the combined risk-stratification ability of cardiac computed tomographic (CT) angiography plaque assessment and high-sensitivity troponin T (hsTnT) in intermediate-risk CAD patients.
- To determine if these modalities improve cardiovascular event prediction beyond traditional risk scores.
Main Methods:
- Prospective, observational study of 521 intermediate-risk patients.
- Quantitative cardiac CT angiography for plaque volume and composition analysis.
- Measurement of hsTnT and high-sensitivity C-reactive protein (hsCRP) in a subset of patients.
- Multivariate Cox regression and integrated discrimination improvement analysis for event prediction.
Main Results:
- Increased hsTnT (≥14 pg/mL) and plaque burden were independently associated with hard cardiac events (P < .01).
- Patients with both elevated hsTnT and plaque burden had the highest event incidence (12.7% annually).
- Patients with low hsTnT and plaque burden experienced no hard events during follow-up.
Conclusions:
- Cardiac CT angiography and hsTnT significantly enhance the prediction of cardiac outcomes in patients with presumed stable CAD.
- This combined approach aids in personalized risk stratification for intermediate-risk patients.
- hsTnT indicates myocardial microinjury, while CT angiography assesses total atherosclerotic burden.
Purpose:
To determine the risk-stratification ability of plaque volume and composition assessment with cardiac computed tomographic (CT) angiography and high-sensitivity troponin T (hsTnT) in patients at intermediate risk for coronary artery disease (CAD).
Materials And Methods:
The study complied with the Declaration of Helsinki and was approved by the local ethics committee. All patients gave written informed consent. Five hundred twenty-one consecutive patients (mean age ± standard deviation, 62 years ± 10; 256 men and 265 women) were included in this prospective, observational, longitudinal, single-center study. Quantitative cardiac CT angiography analysis was performed in all patients (for 7690 coronary segments), whereas biomarkers (hsTnT and high-sensitivity C-reactive protein) were available in 408 patients (78%). To evaluate the incremental value of cardiac CT angiography and hsTnT for the prediction of cardiovascular events, multivariate Cox regression and integrated discrimination improvement analysis were applied.
Results:
In 521 patients, 13 hard cardiac events occurred during a mean follow-up period of 2.3 years ± 1.1 (median, 2.4 years; range, 0.5-4.5 years), while 23 patients underwent late coronary revascularization. The Duke clinical score was 51% ± 30, indicating intermediate risk. The presence of no plaques or purely calcified versus noncalcified plaques, plaque volume according to tertiles, and increased hsTnT (≥14 pg/mL) was independently associated with hard cardiac events (hazard ratio [HR] = 26.08, 95% confidence interval [CI]: 2.78, 244.99; HR = 12.14, 95% CI: 1.87, 78.74; and HR = 10.31, 95% CI: 2.72, 39.0, respectively; P < .01 for all). Patients with increased hsTnT and plaque burden (n = 53) showed the highest incidence for hard cardiac events (annual rate, 12.7%), followed by those with either increased hsTnT or plaque burden (n = 145; annual rate = 0.44%, P < .03), while those with lower hsTnT and plaque burden exhibited excellent outcomes and no hard event during the follow-up duration (n = 210; annual rate = 0%, P < .001).
Conclusion:
Use of hsTnT as a marker of myocardial microinjury and cardiac CT angiography as a marker of the total atherosclerotic burden improves the prediction of cardiac outcome in patients with presumably stable CAD and may aid in personalized risk stratification in patients at intermediate risk.
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