High-Sensitivity Cardiac Troponin I for Risk Stratification in Wild-Type Transthyretin Amyloid Cardiomyopathy

Area of Science:

• Cardiology
• Biomarkers
• Genetics

Background:

• Prognostic thresholds for high-sensitivity cardiac troponin I (hs-cTnI) are not well-defined in wild-type transthyretin amyloid cardiomyopathy.
• Multiple hs-cTnI assays complicate threshold standardization.

Purpose of the Study:

• Assess the prognostic performance of hs-cTnI across different assays in wild-type transthyretin amyloid cardiomyopathy.
• Establish assay-specific hs-cTnI thresholds for improved risk stratification and staging.

Main Methods:

• Multicenter observational study involving patients with wild-type transthyretin amyloid cardiomyopathy.
• Utilized Abbott and Beckman Coulter hs-cTnI assays for testing, and Siemens assay for validation.
• All-cause mortality was the primary outcome measure.

Main Results:

• hs-cTnI was an independent predictor of mortality in both Abbott and Beckman cohorts.
• An hs-cTnI threshold of 80 ng/L demonstrated optimal prognostic performance for 18-month mortality.
• A staging system combining hs-cTnI (>80 ng/L) and natriuretic peptides (NPs) effectively stratified risk in a validation cohort.

Conclusions:

• hs-cTnI is a robust independent predictor of mortality in wild-type transthyretin amyloid cardiomyopathy.
• An hs-cTnI threshold of 80 ng/L offers effective risk stratification, both independently and within a staging system with NPs.