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Association of Longitudinal High-Sensitivity Cardiac Troponin T With Clinical Outcomes in Adult Heart-Transplant
Liqi Cao1, Chulan Ou1,2, Chang Liu1
1Department of Radiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences) Southern Medical University Guangzhou China.
Insights
Serial measurements of high-sensitivity cardiac troponin T (hs-cTnT) predict mortality and major adverse cardiac events in heart transplant recipients. Longitudinal hs-cTnT trends, not just baseline levels, are key indicators of patient outcomes.
Area of Science:
- Cardiology
- Transplantation Medicine
- Biomarker Research
Background:
- Cardiac troponin T (cTnT) is a known mortality predictor in heart transplant recipients.
- The association between longitudinal high-sensitivity cardiac troponin T (hs-cTnT) measurements and clinical outcomes remains under-evaluated.
- Understanding serial hs-cTnT patterns is crucial for assessing post-transplant risks.
Purpose of the Study:
- To investigate the association of three hs-cTnT parameterizations (instantaneous concentration, temporal trend, cumulative exposure) with clinical outcomes.
- To determine the prognostic value of longitudinal hs-cTnT measurements in heart transplant recipients.
- To compare the predictive power of serial hs-cTnT versus baseline levels.
Main Methods:
- Retrospective analysis of 222 heart transplant recipients surviving >30 days post-transplant.
- Utilized joint models to analyze longitudinal hs-cTnT data.
- Primary outcome: all-cause mortality; Secondary outcome: major adverse cardiac events (MACE).
Main Results:
- Both instantaneous hs-cTnT concentration and cumulative hs-cTnT exposure were strongly associated with mortality (HR > 1.8, P < 0.001).
- The temporal trend of hs-cTnT also significantly predicted mortality after adjusting for donor/recipient factors.
- Instantaneous concentration and cumulative exposure linked to MACE incidence (P < 0.05); baseline hs-cTnT lost significance post-adjustment.
Conclusions:
- Longitudinally measured hs-cTnT is an independent predictor of mortality in heart transplant recipients.
- Serial hs-cTnT measurements are also associated with major adverse cardiac events.
- Dynamic changes in hs-cTnT levels provide critical prognostic information beyond single measurements.
Background:
Cardiac troponin T is associated with mortality in heart transplantation recipients, but the association between its longitudinal measurements and clinical outcomes has not been evaluated. This study aimed to determine whether 3 parameterizations of serial hs-cTnT (high-sensitivity cardiac troponin T)-instantaneous concentration, temporal trend, and cumulative exposure-are associated with clinical outcomes in this population.
Methods:
In a retrospective analysis, 222 heart transplantation recipients (median age 50 years, 86% men) who survived >30 days post transplant were included. Joint models were used to analyze the association between longitudinal hs-cTnT and the primary outcome of all-cause mortality and the secondary outcome of major adverse cardiac events.
Results:
Over a median follow-up of 2.3 years, 32 deaths and 41 major adverse cardiac events occurred. Both instantaneous hs-cTnT concentration (hazard ratio [HR], 1.85 [95% CI, 1.48-2.31]; P<0.001) and cumulative hs-cTnT exposure (HR, 1.80 [95% CI, 1.38-2.37]; P<0.001) were strongly associated with mortality. The temporal trend of hs-cTnT was significantly associated with mortality after adjustment for donor and recipient factors. Similarly, instantaneous concentration and cumulative exposure were associated with major adverse cardiac events incidence (both P<0.05). In contrast, baseline hs-cTnT lost its significant association with outcomes after multivariable adjustment.
Conclusions:
Longitudinally measured hs-cTnT is independently associated with mortality and major adverse cardiac events in heart transplant recipients.
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