Cardiac troponin T as a predictor of cardiac death in patients with left ventricular dysfunction
Hironori Nakamura1, Shinichi Niwano1, Hidehira Fukaya1
1Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan.
Insights
Routine cardiac troponin T (cTnT) assessment predicts cardiac death in patients with left ventricular (LV) dysfunction. Higher cTnT levels indicate increased risk, even in non-ischemic conditions.
Area of Science:
- Cardiology
- Biomarkers
- Clinical Prediction
Background:
- Cardiac troponin T (cTnT) is linked to cardiac mortality.
- The predictive value of routine cTnT assessment in patients with left ventricular (LV) dysfunction requires further evaluation.
Purpose of the Study:
- To assess the role of routine cardiac troponin T (cTnT) levels as a predictor of future cardiac death.
- To investigate the association between cTnT levels and cardiac mortality in patients with LV dysfunction eligible for prophylactic implantable cardioverter defibrillator (ICD).
Main Methods:
- Patients with LV ejection fraction ≤ 35% and NYHA class ≥ II were analyzed.
- Patients were stratified into low, intermediate, and high cTnT groups based on serum levels.
- Cardiac death was the primary endpoint, assessed over a 2.2-year follow-up period.
Main Results:
- Seventeen cardiac deaths occurred in 70 patients over 2.2 years.
- Kaplan-Meier analysis revealed a significantly higher risk of cardiac death in the high cTnT group (p<0.001).
- This association persisted in sub-analyses of both ischemic and non-ischemic patient groups; no deaths occurred in the low cTnT group.
Conclusions:
- Stable state cardiac troponin T (cTnT) levels are associated with cardiac death risk in patients with LV dysfunction.
- This predictive relationship holds true even for patients with non-ischemic heart conditions.
- Routine cTnT measurement can aid in risk stratification for cardiac events in this patient population.
Background:
Cardiac troponin T (cTnT) has been reported to be associated with cardiac mortality. In the present study, we evaluated the role of routine assessment of cTnT as a predictor of future cardiac death in patients with left ventricular (LV) dysfunction.
Methods:
Patients who were eligible for prophylactic implantable cardioverter defibrillator (ICD) were included from cardiac catheterization database. Inclusion criteria were patients with LV ejection fraction of ≤ 35% and with New York Heart Association (NYHA) ≥class II. Exclusion criteria were patients with acute coronary syndrome, ICD for secondary prevention, NYHA class IV, and lack of data. The final study patients were divided into the following three groups in accordance with two quartile points of serum cTnT levels: low cTnT, intermediate cTnT, and high cTnT groups. The primary endpoint of this study was cardiac death.
Results:
A total of 70 patients were included (mean age, 62±13 years; male individuals, 56; ischemic, 36; and non-ischemic, 34). During the observation period of 2.2 years, cardiac death was observed in 17 patients (fatal arrhythmic event, 9; heart failure, 7; myocardial infarction, 1). In the Kaplan-Meier analysis, the high cTnT group showed the highest risk among all the groups (p<0.001). Even in sub-analyses for ischemic and non-ischemic patients, the results were the same, and the high cTnT group showed the highest event rate (p<0.05). In contrast, no cardiac death was observed in the low cTnT group.
Conclusion:
The cTnT levels in a stable state were associated with cardiac death in patients with LV dysfunction, even in those with non-ischemic diseases.
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