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High-Sensitivity Cardiac Troponin T Elevation in Hypertrophic Cardiomyopathy Is Associated With Ventricular
Daniel R Burczak1, D Brian Newman1, Allan S Jaffe2
1Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN.
Insights
Elevated high-sensitivity cardiac troponin T (hs-cTnT) levels in hypertrophic cardiomyopathy (HCM) patients are common. Using sex-specific cutoffs, hs-cTnT predicts arrhythmias, but further research is needed to confirm its role in sudden cardiac death (SCD).
Area of Science:
- Cardiology
- Biomarkers
- Genetics
Background:
- Hypertrophic cardiomyopathy (HCM) is a genetic heart muscle disease.
- Sudden cardiac death (SCD) is a major concern in HCM patients.
- High-sensitivity cardiac troponin T (hs-cTnT) is a potential biomarker for cardiac injury.
Purpose of the Study:
- To investigate the association between hs-cTnT levels and SCD risk in patients with HCM.
- To determine if hs-cTnT can predict adverse arrhythmic events in HCM.
Main Methods:
- A prospective cohort of 112 HCM patients was analyzed.
- hs-cTnT levels were measured and compared with clinical data, risk factors, and cardiac events.
- Patients were stratified based on normal vs. elevated hs-cTnT levels, with and without sex-specific cutoffs.
Main Results:
- Elevated hs-cTnT was observed in 62% of patients and correlated with SCD risk factors like ventricular tachycardia and septal thickness.
- Patients with elevated hs-cTnT were more likely to experience ventricular arrhythmias or ICD discharge when sex-specific cutoffs were applied.
- This association was not significant when sex-specific cutoffs were removed.
Conclusions:
- hs-cTnT elevations are frequent in HCM patients.
- Sex-specific hs-cTnT cutoffs may identify HCM patients with increased arrhythmic risk.
- Further investigation is required to establish hs-cTnT as an independent predictor of SCD in HCM.
Objective:
To investigate the relationship between high-sensitivity cardiac troponin T (hs-cTnT) levels and sudden cardiac death (SCD) in patients with hypertrophic cardiomyopathy (HCM).
Methods:
A referral HCM population with prospectively obtained hs-cTnT concentration from March 1, 2018, to April 23, 2020, was reviewed. Patients with end-stage renal disease or an abnormal hs-cTnT level not collected in an outpatient protocolled fashion were excluded. The hs-cTnT level was compared with demographic characteristics, comorbidities, conventional HCM-associated SCD risk factors, imaging, exercise testing, and prior cardiac events.
Results:
Of 112 included patients, 69 (62%) had an elevated hs-cTnT concentration. The level of hs-cTnT correlated with known risk factors for SCD, including nonsustained ventricular tachycardia (P=.049) and septal thickness (P=.02). When patients were stratified by having a normal vs an elevated hs-cTnT concentration, patients with elevated hs-cTnT concentration were more likely to have experienced an implantable cardioverter-defibrillator discharge for ventricular arrhythmia, ventricular arrhythmia with hemodynamic instability, or cardiac arrest (incidence rate ratio, 2.96; 95% CI, 1.11 to 10.2). When sex-specific hs-cTnT cutoffs were removed, this association was no longer present (incidence rate ratio, 1.50; 95% CI, 0.66 to 3.60).
Conclusion:
In a protocolized, outpatient HCM population, hs-cTnT elevations were common and were associated with more arrhythmic expressivity of the HCM substrate as indicated by previous ventricular arrhythmias and appropriate implantable cardioverter-defibrillator shocks only when sex-specific hs-cTnT cutoffs were used. Further research should use different hs-cTnT reference values by sex to determine whether an elevated hs-cTnT value is an independent risk factor for SCD in patients with HCM.
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