| Autor: |
Gommans, Frank, Cramer, Etienne, Fouraux, Michael, Heijmans, Sanne, Michels, Michelle, Timmermans, Janneke, Verheugt, Freek W, De Boer, Rudolf A, Kofflard, Marcel, Brouwer, Marc |
| Zdroj: |
Circulation (Ovid); November 2019, Vol. 140 Issue: Supplement 1 pA10645-A10645, 1p |
| Abstrakt: |
Introduction:Prediction of clinical outcome in hypertrophic cardiomyopathy (HCM) is challenging and still suboptimal. Elevated cardiac troponin T assessed with a highly sensitive assay (hs-cTnT) has been associated with adverse disease characteristics, but data on the association with clinical outcome in HCM are scarce. We sought to assess the association of an elevated hs-cTnT concentration with adverse outcome during long-term clinical follow-up in HCM.Methods:Prospective cohort study of 115 HCM patients who underwent clinical evaluation (genetic testing, echocardiography, exercise testing and Holter monitoring), MRI (cine, LGE and T2-weighted imaging) and biomarker assessment (hs-cTnT, NTproBNP, sST2, Gal-3, GDF-15, CICP). An elevated hs-cTnT concentration was defined as ?14ng/L. Clinical follow-up was systematically performed for the primary composite endpoint of cardiovascular death, unplanned cardiovascular hospitalization, sustained VT/VF and appropriate ICD therapy.Results:Elevated hs-cTnT was present in 28 of 115 (24%) HCM patients. During a median follow-up time of 5.0 years (IQR: 4.6-5.1) 10 of 28 (36%) patients with an elevated hs-cTnT reached the primary endpoint compared to 13 of 85 (15%) patients without elevated hs-cTnT (p=0.02). Using Cox regression analysis, elevated hs-cTnT was univariately associated with the primary endpoint (HR: 2.43 (95%CI: 1.06-5.54, p=0.04). Also female sex, diabetes, previous syncope and an LV outflow tract gradient ?30mmHg were associated with the primary endpoint. In multivariable analysis, elevated hs-cTnT remained an independent predictor (aHR: 2.83 (95%CI: 1.18-6.79, p=0.02) (Figure).Conclusions:In our well-defined HCM cohort we demonstrate that an elevated hs-cTnT concentration is an independent predictor of adverse clinical outcome. With a single measurement of cardiac troponin risk stratification may be improved in HCM during a course of 5-years of follow-up. |
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