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Prognostic value of high-sensitive troponin T in patients with severe aortic stenosis undergoing valve replacement
Alaa Salama1, Ghada Ibrahim1, Mohammad Fikry1
1Cardiology Department, Zagazig University, Zagazig, Egypt.
Insights
High-sensitive troponin T (hs-TnT) predicts poor prognosis in severe aortic stenosis patients post-aortic valve replacement. hs-TnT and global longitudinal strain (GLS) are key predictors of major adverse cardiovascular events.
Area of Science:
- Cardiology
- Biomarkers
- Echocardiography
Background:
- Aortic stenosis (AS) is a significant cause of mortality.
- Severe AS with preserved left ventricular ejection fraction (LVEF) presents unique prognostic challenges.
- Surgical aortic valve replacement (AVR) is a standard treatment for symptomatic severe AS.
Purpose of the Study:
- To evaluate the prognostic value of high-sensitive troponin T (hs-TnT) in patients with severe AS and preserved LVEF after AVR.
- To identify predictors of major adverse cardiovascular events (MACE) in this patient cohort.
- To explore the relationship between hs-TnT, global longitudinal strain (GLS), and MACE.
Main Methods:
- Recruitment of 108 patients with severe symptomatic AS between April 2020 and February 2022.
- Comprehensive echocardiography including assessment of LVEF, LV mass index, left atrium volume index, and GLS.
- Measurement of hs-TnT levels and 6-month follow-up for MACE (cardiac death, heart failure re-admission, fatal arrhythmia).
Main Results:
- Seventeen patients experienced MACE, including 8 cardiac deaths.
- A statistically significant difference in MACE rates was observed between patients with normal and elevated hs-TnT levels (log-rank test, p=0.025).
- Multivariate analysis identified hs-TnT (p<0.01) and GLS (p=0.022) as significant predictors of MACE, with a hs-TnT cutoff of 238.25 predicting MACE with 70% sensitivity and 81% specificity.
Conclusions:
- Elevated hs-TnT is associated with a poor short-term prognosis following AVR in severe AS patients.
- hs-TnT and GLS are significant predictors of future MACE in severe symptomatic AS patients with preserved LVEF undergoing AVR.
- Elevated hs-TnT and impaired GLS may indicate the need for early intervention, even in asymptomatic severe AS.
Background:
Aortic stenosis (AS) is a well-known cause of mortality. We aimed to assess the prognostic value of high-sensitive troponin T (hs-TnT) in symptomatic patients with severe AS and preserved left ventricular ejection fraction (LVEF) after surgical aortic valve replacement (AVR).
Patients And Methods:
The study recruited patients with severe symptomatic AS fulfilling the inclusion criteria in the period between April 2020 and February 2022. Comprehensive echocardiography was done. The following parameters were assessed: AS severity, LV mass index (LVMI), left atrium volume index (LAVI), and LVEF. E/e' and LVEF were calculated using the biplane method of Simpsons. Global longitudinal strain (GLS) was assessed by speckle tracking echocardiography. Peripheral blood samples were collected for hs-TnT measurement. All patients underwent surgical AVR. The patients were followed for the following 6 months for major adverse cardiovascular events (MACE). MACE was defined as cardiac death, re-admission for congestive heart failure (CHF) and fatal arrhythmia.
Results:
One hundred and eight patients (mean age = 58.7 ± 7.68 years) with severe AS were recruited. Seventeen patients presented with MACE including 8 cardiac deaths. We divided the patients into two groups based on the normal hs-TnT values. The Kaplan-Meier curve revealed a statistically significant difference in MACE rate among troponin groups (log-rank test = 5.06, p = 0.025). There was significant difference between both groups regarding GLS with smaller GLS in negative hs-TnT group. In multivariate analysis, GLS and hs-TnT were significantly associated with MACE (p = 0.022 and < 0.01 respectively). The cutoff value of hs-TnT of 238.25 had a sensitivity of 70% and a specificity of 81% for predicting future MACE. There was a significant correlation between GLS and troponin (p < 0.001).
Conclusions:
hs-TnT is associated with bad short-term prognosis after AVR. hs-TnT and GLS could be significant predictors for future MACE in patients with severe symptomatic AS and preserved LVEF who underwent AVR. Elevated hs-TnT and impaired GLS could set an indication of early intervention in asymptomatic severe AS.
