scholarly journals Elevated high-sensitivity troponin T levels at 1-year follow-up are associated with increased long-term mortality after TAVR

2020 ◽  
Author(s):  
Hatim Seoudy ◽  
Moritz Lambers ◽  
Vincent Winkler ◽  
Linnea Dudlik ◽  
Sandra Freitag-Wolf ◽  
...  
Keyword(s):  
Troponin T ◽  
High Sensitivity ◽  
Left Ventricular ◽  
Adverse Outcomes ◽  
Chronic Obstructive ◽  
High Sensitivity Troponin ◽  
High Sensitivity Troponin T ◽  
Long Term Mortality

Abstract Background Elevated pre-procedural high-sensitivity troponin T (hs-TnT) levels predict adverse outcomes in patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR). It is unknown whether elevated troponin levels still provide prognostic information during follow-up after successful TAVR. We evaluated the long-term implications of elevated hs-TnT levels found at 1-year post-TAVR. Methods and results The study included 349 patients who underwent TAVR for severe AS from 2010–2019 and for whom 1-year hs-TnT levels were available. Any required percutaneous coronary interventions were performed > 1 week before TAVR. The primary endpoint was survival time starting at 1-year post-TAVR. Optimal hs-TnT cutoff for stratifying risk, identified by ROC analysis, was 39.4 pg/mL. 292 patients had hs-TnT < 39.4 pg/mL (median 18.3 pg/mL) and 57 had hs-TnT ≥ 39.4 pg/mL (median 51.2 pg/mL). The high hs-TnT group had a higher median N-terminal pro-B-type natriuretic peptide (NT-proBNP) level, greater left ventricular (LV) mass, higher prevalence of severe diastolic dysfunction, LV ejection fraction < 35%, severe renal dysfunction, and more men compared with the low hs-TnT group. All-cause mortality during follow-up after TAVR was significantly higher among patients who had hs-TnT ≥ 39.4 pg/mL compared with those who did not (mortality rate at 2 years post-TAVR: 12.3% vs. 4.1%, p = 0.010). Multivariate analysis identified 1-year hs-TnT ≥ 39.4 pg/mL (hazard ratio 2.93, 95% CI 1.91–4.49, p < 0.001), NT-proBNP level > 300 pg/mL, male sex, an eGFR < 60 mL/min/1.73 m2 and chronic obstructive pulmonary disease as independent risk factors for long-term mortality after TAVR. Conclusions Elevated hs-TnT concentrations at 1-year after TAVR were associated with a higher long-term mortality. Graphic abstract

scholarly journals Classification, prevalence, and outcomes of anticancer therapy-induced cardiotoxicity: the CARDIOTOX registry

2020 ◽  
Vol 41 (18) ◽  
pp. 1720-1729 ◽  
Author(s):  
José López-Sendón ◽  
Carlos Álvarez-Ortega ◽  
Pilar Zamora Auñon ◽  
Antonio Buño Soto ◽  
Alexander R Lyon ◽  
...  
Keyword(s):  
Troponin T ◽  
Myocardial Damage ◽  
High Sensitivity ◽  
Anticancer Therapy ◽  
Left Ventricular ◽  
Lv Function ◽  
Cancer Therapies ◽  
Research Practices ◽  
High Sensitivity Troponin T

Abstract Aim Cardiotoxicity (CTox) is a major side effect of cancer therapies, but uniform diagnostic criteria to guide clinical and research practices are lacking. Methods and results We prospectively studied 865 patients, aged 54.7 ± 13.9; 16.3% men, scheduled for anticancer therapy related with moderate/high CTox risk. Four groups of progressive myocardial damage/dysfunction were considered according to current guidelines: normal, normal biomarkers (high-sensitivity troponin T and N-terminal natriuretic pro-peptide), and left ventricular (LV) function; mild, abnormal biomarkers, and/or LV dysfunction (LVD) maintaining an LV ejection fraction (LVEF) ≥50%; moderate, LVD with LVEF 40–49%; and severe, LVD with LVEF ≤40% or symptomatic heart failure. Cardiotoxicity was defined as new or worsening of myocardial damage/ventricular function from baseline during follow-up. Patients were followed for a median of 24 months. Cardiotoxicity was identified in 37.5% patients during follow-up [95% confidence interval (CI) 34.22–40.8%], 31.6% with mild, 2.8% moderate, and 3.1% with severe myocardial damage/dysfunction. The mortality rate in the severe CTox group was 22.9 deaths per 100 patients-year vs. 2.3 deaths per 100 patients-year in the rest of groups, hazard ratio of 10.2 (95% CI 5.5–19.2) (P &lt; 0.001). Conclusions The majority of patients present objective data of myocardial injury/dysfunction during or after cancer therapy. Nevertheless, severe CTox, with a strong prognostic relationship, was comparatively rare. This should be reflected in protocols for clinical and research practices.

scholarly journals Early overexpression of miR-499 in non-ST elevation acute coronary syndromes predicts long-term risk of major adverse cardiac events

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
D Miskowiec ◽  
K Kupczynska ◽  
M Simiera ◽  
B Michalski ◽  
D Filipiak-Strzecka ◽  
...  
Keyword(s):  
Hospital Admission ◽  
Troponin T ◽  
High Sensitivity ◽  
Funding Source ◽  
Cardiac Events ◽  
Adverse Cardiac Events ◽  
Median Level ◽  
High Sensitivity Troponin T

Abstract Background Some studies reported utility of microRNAs in myocardial infarction diagnostic process, whereas their prognostic remains unclear. Aim To evaluate the prognostic value of five circulating miRs (miR-1, miR-21, miR-133a, miR-208, miR-499) levels for predicting major adverse cardiac events (MACE), including death, nonfatal myocardial infarction (MI) or cardiovascular rehospitalization (reh.) in patients with NSTE-ACS. Material and methods In our prospective, single-center observational study we recruited patients (pts) with NSTE-ACS with symptoms onset &lt;24 hours before the hospital admission and age, gender-matched patients with stable coronary artery disease (SCAD) as controls. Blood was sampled twice (at admission and 4h after in NSTE-ACS and once in SCAD). Relative expression of miRs were calculated using the ΔΔCt method after normalization to the cel-miR-39 spiked-in control. The mean value of miRs relative expression from two time samples in NSTE-ACS pts were used for further analysis. Subjects were categorized according to mean miRs expression at hospital admission into two group (≤ or &gt; median level of miRs). Results 103 NSTE-ACS pts (median age 67 years, 68% male) were included in this study. During median 1569 (IQR 935–1842) days of follow-up the primary endpoint (MACE) occurred in 66 (64.1%) pts: 18 pts (18.7%) died, 30 pts (20%) presented with MI and 85 pts (56.7%) were readmitted. In a Cox proportional-hazards regression model miR-499 expression &gt; median level (HR=1.82, 95% CI 1.07–3.09) and high-sensitivity troponin T level (HR=1.24, 95% CI 1.05–1.46) were independent predictors of MACE in long term observation, even after adjustment for other covariates (including other miRNAs). Incidence of MI [34% vs 10%, HR=4.1 (2.0–8.5)], rehospitalization for cardiovascular reasons [67% vs 49%, HR=2.1 (1.3–3.3)] and MACE [76% vs 55%, HR=2.2 (1.5–3.5)] was significantly higher in pts with elevated (&gt; median) miR-499 levels at hospital admission. None of analyzed miRNAs was related to long-term mortality, whereas the left ventricular ejection fraction (EF) has been identified as the only one survival predictor (HR=0.95, 95% CI 0.92–0.98). Conclusions Elevated miR-499 levels independently of high sensitivity troponin T levels in early phase of NSTE-ACS are related to increased rate of MACE in 4-year follow-up. Figure 1. miR499 and MACE Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): This study was supported by the Polish Ministry of Science and Higher Education “Diamond Grant” program.

Association of High-Sensitivity Troponin T With Left Ventricular Dysfunction in Ankylosing Spondylitis

2020 ◽  
Vol 26 (3) ◽  
pp. 87-93 ◽  
Author(s):  
Serdar Turkmen ◽  
Lutfu Askin ◽  
Kader Eliz Uzel ◽  
Huseyin Nacar ◽  
Veysi Kavalci ◽  
...  
Keyword(s):  
Ankylosing Spondylitis ◽  
Left Ventricular Dysfunction ◽  
Ventricular Dysfunction ◽  
Troponin T ◽  
High Sensitivity ◽  
Left Ventricular ◽  
High Sensitivity Troponin ◽  
High Sensitivity Troponin T
Sign in / Sign up

Export Citation Format

Share Document