Relation of Highly-Sensitive Cardiac Troponin T in Hypertrophic Cardiomyopathy to Left Ventricular Mass and Cardiovascular Risk

Jan 27, 2014
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Authors:
Cramer G, Bakker J, Gommans F, et al.
Citation:
Am J Cardiol 2014;Jan 16:[Epub ahead of print].
Summary By:
Debabrata Mukherjee, MD, FACC

Study Questions:

What are the associations between troponin and left ventricular (LV) cardiac mass measures among individuals with hypertrophic cardiomyopathy (HC) and the Framingham Heart 10-year risk score (FH10yrs) as a measure of the predicted cardiovascular disease (CVD) risk?

Methods:

In an observational single-center study of 62 HC patients without a history of CVD, the investigators assessed the FH10yrs, LV mass index (LVMI) using magnetic resonance imaging, and highly-sensitive cardiac troponin T (hs-cTnT).

Results:

Hs-cTnT (>3 ng/L) was detectable in 74% of patients (46/62). Hs-cTnT was elevated in 26% (16/62) of patients (≥ the 99th percentile reference limit of 14 ng/L). For those with levels between 3 and 14 ng/L, patients were older, more often had hypertension, and the FH10yrs was higher. Hs-cTnT correlated positively with LVMI (p < 0.001) and maximal wall thickness (p < 0.001). In addition, LVMI and hypertension were independently associated with increasing hs-cTnT concentrations in linear regression. Using multivariable binary logistic regression, both LVMI and FH10yrs were independently associated with a detectable hs-cTnT. In contrast, only LVMI was associated with an elevated hs-cTnT.

Conclusions:

The authors concluded that hs-cTnT was detectable in three quarters, and elevated in a quarter of patients with HC.

Perspective:

The present study in patients with HC demonstrates that troponin release seems to be related to both cardiac mass and the risk of CVD, with the interesting finding that the contribution of both factors seems to differ in relation to the serum troponin concentration. Both hypertension and LVMI are related to increasing troponin concentrations independent of other variables. Notably, the fact that the FH10yrs was independently associated with a detectable troponin (i.e., >3 ng/L), but not with an elevated troponin (≥99th percentile) suggests that LV mass rather than the predicted risk of CVD is the main driver for an elevated troponin in patients with HC.

Keywords: Hypertrophy, Left Ventricular, Cardiomyopathy, Hypertrophic, Heart Failure, Cardiovascular Diseases, Troponin T, Risk Factors, Magnetic Resonance Imaging, Hypertension


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