High-sensitivity troponin T for prediction of left ventricular function and infarct size one year following
Sebastian Johannes Reinstadler1, Hans-Josef Feistritzer1, Gert Klug1
1Department of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstraße 35, A-6020 Innsbruck Austria.
Insights
Early high-sensitivity cardiac troponin T (hs-cTnT) levels accurately predict long-term heart function and infarct size after ST-elevation myocardial infarction (STEMI). hs-cTnT alone is sufficient for prognosis, outperforming combinations with other biomarkers.
Area of Science:
- Cardiology
- Biomarker Research
- Myocardial Infarction
Background:
- Limited data exists on the relationship between high-sensitivity cardiac troponin T (hs-cTnT) and long-term outcomes post-ST-elevation myocardial infarction (STEMI).
- Assessing long-term myocardial function and infarct size is crucial for patient management after STEMI.
Purpose of the Study:
- To evaluate early hs-cTnT concentrations for predicting myocardial function and infarct size.
- To assess these parameters using cardiac magnetic resonance imaging (CMR) one year after STEMI.
Main Methods:
- Sixty-six STEMI patients undergoing primary percutaneous coronary intervention (PCI) were studied.
- Serial hs-cTnT, creatine kinase (CK), hs-CRP, and LDH levels were measured post-PCI.
- Cardiac magnetic resonance imaging (CMR) was performed within the first week and at 12 months.
Main Results:
- Peak hs-cTnT concentrations strongly correlated with left ventricular ejection fraction (LVEF) and infarct size (IS) at baseline and 12 months.
- Peak hs-cTnT achieved an AUC of 0.82 for predicting reduced LVEF and 0.89 for large IS at 12 months.
- Combining hs-cTnT with CK, hs-CRP, or LDH did not significantly improve predictive value for LVEF or IS.
Conclusions:
- Serial and peak hs-cTnT concentrations are reliable predictors of long-term LVEF and IS in stable STEMI patients after successful PCI.
- hs-cTnT alone provides sufficient prognostic information, negating the need for additional biomarkers like CK, hs-CRP, or LDH.
Background:
Data relating high-sensitivity cardiac troponin T (hs-cTnT) to long-term myocardial function and infarct size in patients after ST-elevation myocardial infarction (STEMI) are lacking. We aimed to evaluate the use of early hs-cTnT concentrations for prediction of myocardial function and infarct size assessed by cardiac magnetic resonance imaging (CMR) one year following STEMI.
Methods:
Sixty-six patients, revascularized by primary percutaneous coronary intervention (PCI) for first-time STEMI, were enrolled in this observational study. Serial hs-cTnT, creatine kinase (CK), high-sensitivity C-reactive protein (hs-CRP) and lactate dehydrogenase (LDH) levels were measured on admission, 6 h, 12 h, and 24 h post-PCI. Patients underwent CMR within the first week and 12months thereafter.
Results:
Except for admission hs-cTnT, all single time point and peak hs-cTnT concentrations showed significant correlations with left ventricular ejection fraction (LVEF: r=-0.404 to -0.517, all ps<0.01) and infarct size (IS: r=0.421 to 0.700, all ps<0.01) at baseline and follow-up. The area under the curve (AUC) of peak hs-cTnT was 0.82 (95% CI 0.71-0.92) for the prediction of decreased LVEF (<55%) and 0.89 (95% CI 0.81-0.97) for the prediction of large IS (>8%) at 12months. The combination of all four biomarkers resulted in an AUC of 0.82 and 0.92 for the prediction of reduced LVEF and large IS at 12months, respectively (both ps>0.05).
Conclusion:
In stable STEMI patients successfully revascularized by primary PCI, serial and peak concentrations of hs-cTnT are closely correlated to long-term LVEF and IS. Combination of hs-cTnT with CK, hs-CRP, or LDH did not add any significant prognostic value as compared with hs-cTnT alone.
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