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High-sensitive troponin-T in adult congenital heart disease
Jannet A Eindhoven1, Jolien W Roos-Hesselink1, Annemien E van den Bosch1
1Department of cardiology, Thorax Center, Erasmus MC, Rotterdam, The Netherlands.
Insights
Elevated high-sensitive troponin-T (hs-TnT) levels are common in adult congenital heart disease (ACHD) patients, particularly those with systemic right ventricle or pulmonary hypertension. This finding suggests hs-TnT may be a valuable prognostic marker in ACHD.
Area of Science:
- Cardiology
- Biomarker Research
- Adult Congenital Heart Disease
Background:
- Adult congenital heart disease (ACHD) patients face risks of arrhythmias, heart failure, and sudden death.
- High-sensitive troponin-T (hs-TnT) is standard for acute coronary syndrome but also indicates cardiac function and prognosis in other heart conditions.
Purpose of the Study:
- To determine hs-TnT levels in ACHD patients.
- To explore the relationship between hs-TnT, cardiac function, and other biomarkers in ACHD.
Main Methods:
- Consecutive ACHD outpatients underwent same-day echocardiography, exercise testing, and venipuncture.
- hs-TnT levels were measured and analyzed in relation to clinical parameters.
Main Results:
- 41% of 587 ACHD patients had detectable hs-TnT; 8% exceeded the 99th percentile (14 ng/L).
- Elevated hs-TnT was associated with systemic RV, pulmonary hypertension, older age, NYHA class II+, systolic dysfunction, and non-sinus rhythm.
- hs-TnT correlated significantly with NT-proBNP (r=0.400, p<0.001).
Conclusions:
- A significant proportion of stable ACHD patients exhibit hs-TnT levels above the 99th percentile.
- Elevated hs-TnT is linked to specific conditions like systemic RV and pulmonary hypertension.
- hs-TnT's correlation with NT-proBNP and ventricular function suggests promising predictive value in ACHD, warranting further research.
Background:
Adult congenital heart disease (ACHD) patients are at risk of late complications including arrhythmias, heart failure and sudden death. High-sensitive troponin-T (hs-TnT) is the standard for diagnosing acute coronary syndrome, but is also associated with cardiac function and prognosis in other cardiac diseases. We aimed to describe hs-TnT level in ACHD patients, and determine its relationship with cardiac function and other biomarkers.
Methods:
Consecutive ACHD patients, visiting the outpatient clinic, underwent echocardiography, exercise testing and venipuncture on the same day.
Results:
In total 587 patients were included (median age 33 [IQR 25-41] years, 58% male, 90% NYHA class I). hs-TnT was above the detection limit of 5 ng/L in 241 patients (41%), of whom 47 (8%) had hs-TnT levels above the 99th percentile of normal of 14 ng/L. hs-TnT levels were highest in patients with a systemic RV or pulmonary hypertension. Patients with normal or non-detectable hs-TnT were younger (32 [IQR 24-40] years) than patient with elevated hs-TnT (42 [IQR 36-60] years, p<0.001). The prevalence of hs-TnT ≥14 ng/L was higher in patients with NYHA ≥II (36%, p<0.001), systemic systolic dysfunction (38%, p<0.001), non-sinus rhythm (43%, p<0.001) and elevated pulmonary pressures (39%, p<0.001). hs-TnT was correlated with NT-proBNP (r=0.400, p<0.001).
Conclusions:
hs-TnT above the 99th percentile of normal is observed in a non-trivial portion of stable ACHD patients, especially in those with a systemic RV or elevated pulmonary pressures. Since this biomarker of myocardial damage is related to NT-proBNP and ventricular function, its potential predictive value in ACHD patients seems promising and further investigation of underlying mechanisms is warranted.
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