Chronic troponin elevation assessed by myocardial T1 mapping in patients with stable coronary artery disease
Carlos Alexandre W Segre1, James A de Lemos2, Antonildes Nascimento Assunção Junior1
1Heart Institute (InCor) University of São Paulo Clinics Hospital, Sao Paulo, Brazil.
Insights
Chronic troponin release in patients with coronary artery disease is linked to myocardial tissue changes. T1 mapping revealed associations between troponin levels and diffuse edema or fibrosis in normal hearts.
Area of Science:
- Cardiology
- Biomarkers
- Medical Imaging
Background:
- Sensitive assays can detect chronic cardiac troponin elevation without acute coronary syndromes.
- Clinically silent ischemic episodes in chronic coronary artery disease may lead to sustained troponin release.
- T1 mapping offers quantitative assessment of cardiac tissue characteristics.
Purpose of the Study:
- To investigate the association between chronic troponin release and myocardial tissue characteristics using T1 mapping.
- To explore relationships in patients with anatomically and functionally normal hearts and stable coronary artery disease.
Main Methods:
- Assessed cardiac troponin I concentrations and cardiovascular magnetic resonance T1 mapping parameters.
- Included patients with stable coronary artery disease, no prior myocardial infarction, and normal cardiac function.
- Analyzed native T1 and extracellular volume (ECV) values in relation to troponin levels.
Main Results:
- Native T1 and ECV values increased across troponin tertiles (p < 0.01).
- Cardiac troponin I correlated with native T1 (R=0.33, P=0.012) and ECV (R=0.3, P=0.025).
- Troponin I was independently associated with native T1 and ventricular mass index in multivariable analysis.
Conclusions:
- In patients with chronic coronary artery disease and normal hearts, troponin I levels correlate with T1 mapping parameters.
- Findings suggest diffuse myocardial edema or fibrosis may be linked to chronic troponin release.
- T1 mapping may help characterize myocardial changes associated with chronic troponin elevation.
Background:
Cardiac troponin detected with sensitive assays can be chronically elevated, in the absence of unstable coronary syndromes. In patients with chronic coronary artery disease, clinically silent ischemic episodes may cause chronic troponin release. T1 mapping is a cardiovascular magnetic resonance technique useful in quantitative cardiac tissue characterization. We selected patients with anatomically and functionally normal hearts to investigate associations between chronic troponin release and myocardial tissue characteristics assessed by T1 mapping.
Methods:
We investigated the relationship between cardiac troponin I concentrations and cardiovascular magnetic resonance T1 mapping parameters in patients with stable coronary artery disease enrolled in MASS V study before elective revascularization. Participants had no previous myocardial infarction, negative late gadolinium enhancement, normal left ventricular function, chamber dimensions and wall thickness.
Results:
A total of 56 patients were analyzed in troponin tertiles: nativeT1 and extracellular volume (ECV) values (expressed as means ± standard deviations) increased across tertiles: nativeT1 (1006 ± 27 ms vs 1016 ± 27 ms vs 1034 ± 37 ms, ptrend = 0.006) and ECV (22 ± 3% vs 23 ± 1.9% vs 25 ± 3%, ptrend = 0.007). Cardiac troponin I concentrations correlated with native T1(R = 0.33, P = .012) and ECV (R = 0.3, P = .025), and were independently associated with nativeT1 (P = .049) and ventricular mass index (P = .041) in multivariable analysis.
Conclusion:
In patients with chronic coronary artery disease and structurally normal hearts, troponin I concentrations correlated with T1 mapping parameters, suggesting that diffuse edema or fibrosis scattered in normal myocardium might be associated with chronic troponin release.
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