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Association between Troponin Elevation and Decreased Myocardial Blood Flow Reserve in Patients without Obstructive
Ning Yang1, Rongzhen Zhang2,3, Chaoqun Zhao4
1Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin, China, ynhyd2018@163.com.
Insights
Elevated high-sensitivity troponin I (hs-TnI) in patients with chest pain but no obstructive coronary artery disease indicates poorer prognosis. This biomarker is linked to reduced myocardial perfusion and increased cardiovascular events.
Area of Science:
- Cardiology
- Biomarkers
- Diagnostic Imaging
Background:
- Chest pain without obstructive coronary artery disease (CAD) presents a diagnostic challenge.
- Identifying prognostic factors is crucial for managing these patients.
- High-sensitivity troponin I (hs-TnI) is a potential biomarker for risk stratification.
Purpose of the Study:
- To assess the association between hs-TnI levels and prognosis in patients presenting with chest pain but without obstructive CAD.
- To investigate the relationship between hs-TnI and myocardial perfusion measured by myocardial contrast echocardiography (MCE).
Main Methods:
- A cohort of 489 patients with chest pain and non-obstructive coronary stenosis (<50%) was studied.
- hs-TnI levels and myocardial blood flow reserve (MBFR) via stress MCE were measured.
- Patients were followed for major adverse cardiovascular events; Cox models were used for analysis.
Main Results:
- Elevated hs-TnI was observed in 52.6% of patients and associated with older age, atrial fibrillation, higher left ventricular mass index, and lower MBFR.
- Elevated hs-TnI independently correlated with reduced MBFR (OR=1.145, p<0.001).
- Patients with elevated hs-TnI showed a significantly higher cumulative event rate (log-rank p=0.002).
Conclusions:
- Elevated hs-TnI is linked to diminished myocardial perfusion in patients with chest pain and non-obstructive CAD.
- Higher hs-TnI levels predict an increased incidence of cardiovascular events in this population.
- hs-TnI serves as a valuable prognostic marker in patients with chest pain and without significant coronary artery stenosis.
Introduction:
To study the prognostic factors of patients with chest pain and without obstructive coronary artery disease is of great significance for the management of such patients. We assessed whether a high-sensitivity troponin I (hs-TnI) is associated with prognosis in patients with chest pain and without obstructive coronary artery disease.
Methods:
From 2011 to 2017, 489 consecutively hospitalized patients with chest pain and without significant coronary artery stenosis (<50%) were tested for hs-TnI and underwent stress myocardial contrast echocardiography (MCE). Myocardial blood flow reserve (MBFR) was measured by stress MCE. Patients were followed (median, 41 months) for composite endpoints, including cardiovascular death and non-fatal myocardial infarction. Cox proportional hazards models were performed to determine associations between hs-TnI and the composite endpoints.
Results:
Among 489 patients with chest pain and without significant coronary artery stenosis, 257 patients (52.6%) had elevated hs-TnI. Compared to patients with normal hs-TnI, patients with elevated hs-TnI were older (p = 0.013) and had a higher prevalence of atrial fibrillation (p = 0.003), higher left ventricular mass index (p = 0.002) and E/e' septal (p < 0.001), and a lower MBFR (p < 0.001). After adjustment, there was still a significant association between hs-TnI and MBFR (odds ratio = 1.145; 95% confidence interval [CI], 1.079-1.214; p < 0.001). Compared with patients with normal hs-TnI, patients with elevated hs-TnI had a greater cumulative event rate (log-rank p = 0.002). Males (hazard ratio [HR], 4.770; 95% CI, 1.175-19.363; p = 0.029) and reduced MBFR (HR, 2.496; 95% CI, 1.446-4.311; p = 0.001) were risk factors associated with composite endpoints in patients with elevated hs-TnI.
Conclusions:
In patients with chest pain and without obstructive coronary artery disease, elevated hs-TnI is associated with decreased myocardial perfusion by contrast echocardiography as well as a higher incidence of cardiovascular events.
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