Usefulness of High Sensitivity Troponin T to Predict Long-Term Left Ventricular Dysfunction After ST-Elevation
Moman A Mohammad1, Sasha Koul1, Jacob Thomsen Lønborg2
1Department of Cardiology, Clinical Sciences, Lund University, Skane University Hospital, Lund, Sweden.
Insights
High-sensitivity troponin T (hs-cTnT) effectively predicts long-term left ventricular dysfunction after ST-elevation myocardial infarction (STEMI). A peak hs-cTnT level below 3,500 ng/L can rule out significant dysfunction, aiding risk stratification.
Area of Science:
- Cardiology
- Biomarkers
- Medical Imaging
Background:
- Current guidelines recommend transthoracic echocardiography (TTE) and clinical scores for risk stratification post-ST-elevation myocardial infarction (STEMI).
- High-sensitivity troponin T (hs-cTnT) is known to predict outcomes after STEMI, but its predictive value relative to other tools needs clarification.
Purpose of the Study:
- To compare the predictive value of hs-cTnT against other established risk assessment tools in patients with STEMI.
- To evaluate hs-cTnT's ability to predict long-term left ventricular systolic dysfunction.
Main Methods:
- A post-hoc analysis of 578 STEMI patients from the Third Danish Study of Optimal Acute Treatment of Patients with ST-segment Elevation Myocardial Infarction trial.
- Cardiac magnetic resonance imaging (CMR) during hospitalization and TTE at 1-year follow-up were utilized.
- hs-cTnT was compared with CKMB, CMR-derived infarct size (IS)/left ventricular ejection fraction (LVEF), discharge TTE-assessed LVEF, and GRACE/TIMI risk scores.
Main Results:
- No significant difference was found between hs-cTnT and early CMR-assessed IS or LVEF in predicting LVEF ≤40% at 1 year (AUCs: hs-cTnT 0.82, IS 0.85, LVEF 0.87).
- hs-cTnT showed comparable predictive value to predischarge TTE-assessed LVEF (AUC 0.85), outperforming CKMB (AUC 0.63), GRACE (AUC 0.61), and TIMI (AUC 0.70) scores.
- A peak hs-cTnT value <3,500 ng/L demonstrated a 98% probability of ruling out LVEF ≤40% at 1 year.
Conclusions:
- hs-cTnT is a potent predictor of long-term left ventricular dysfunction in STEMI patients undergoing PCI.
- Its general availability and high predictive accuracy make hs-cTnT a valuable clinical tool for risk stratification.
- Identifying patients at high risk for LV dysfunction can be facilitated by hs-cTnT measurement.
Abstract:
Guidelines recommend the use of transthoracic echocardiography (TTE) and clinical scores to risk stratify patients after ST-elevation myocardial infarction (STEMI). High sensitivity troponin T (hs-cTnT) is predictive of outcome after STEMI but the predictive value of hs-cTnT relative to other risk assessment tools has not been established. We aimed to compare the predictive value of hs-cTnT to other risk assessment tools in patients with STEMI. A subset of 578 patients with STEMI were included in this post-hoc study from the Third DANish Study of Optimal Acute Treatment of Patients with ST-segment Elevation Myocardial Infarction trial. Patients underwent cardiac magnetic resonance imaging (CMR) during index hospitalization as well as TTE at 1 year after their STEMI. The predictive value of hs-cTnT was compared with CKMB, infarct size (IS)/left ventricular ejection fraction (LVEF) assessed with CMR, LVEF assessed at discharge with TTE and the Global Registry of Acute Coronary Events (GRACE) and Thrombolysis in Myocardial Infarction (TIMI) risk-scores. The primary outcome was LV systolic dysfunction defined as LVEF ≤40% after 1 year on TTE. The area under the receiver operating characteristic curve analyses showed no significant difference between hs-cTnT and early CMR-assessed IS or LVEF in predicting subsequent LVEF ≤40%. Area under the curve for hs-cTnT was 0.82, 0.85 for IS (p = 0.22), and 0.87 for LVEF (p = 0.23). For predischarge TTE-assessed LVEF, the value was 0.85 (p = 0.45), 0.63 for creatine kinase-MB (p <0.001), 0.61 for the GRACE score (p <0.001), and 0.70 for the TIMI score (p = 0.02). A peak hs-cTnT value <3,500 ng/L ruled out LVEF ≤40% with probability of 98%. In conclusion, in patients presenting with STEMI undergoing PCI, hs-cTnT level strongly predicted long-term LV dysfunction and could be used as a clinical risk stratification tool to identify patients at high risk of progressing to LV dysfunction due to its general availability and high-predictive accuracy.
More Related Videos
07:40Impact of High-intensity Interval Exercise and Moderate-Intensity Continuous Exercise on the Cardiac Troponin T Level at an Early Stage of Training
Published on: October 10, 2019
10:12A Sensitive and Specific Quantitation Method for Determination of Serum Cardiac Myosin Binding Protein-C by Electrochemiluminescence Immunoassay
Published on: August 8, 2013
Related Concept Videos
01:20Blood Studies for Cardiovascular System I: Cardiac Biomarkers
The essential diagnostic tools for detecting myocardial necrosis and monitoring individuals suspected of having acute coronary syndrome (ACS) include:
Troponins
Troponins, particularly cardiac troponins I and T, are the most precise and sensitive markers of myocardial injury. They are detectable within 4-6 hours of myocardial injury and remain...
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:30Acute Coronary Syndrome I: Introduction
01:22Rheumatic Heart Disease II: Clinical Manifestations and Diagnostic Studies
01:26Exercise Stress Test
Exercise stress testing, commonly known as a treadmill test, is a noninvasive procedure used to evaluate cardiovascular function and diagnose heart conditions.
Definition
An exercise stress test measures the heart's response to exertion using a treadmill or stationary bicycle. Chest electrodes record the heart's electrical activity through an ECG, and blood pressure is monitored regularly.
Purposes
01:27Myocarditis II: Clinical Features and Diagnostic Tests