Abstract 15293: Increased Level of Cardiac Troponin T is a Clue of Cardiac Amyloidosis in Patients With Myocardial Hypertrophy

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Seiji Takashio ◽  
Megumi Yamamuro ◽  
Toshihisa Anzai ◽  
Hisao Ogawa
Keyword(s):  
Endomyocardial Biopsy ◽  
Cardiac Troponin ◽  
Cardiac Amyloidosis ◽  
Myocardial Hypertrophy ◽  
Troponin T ◽  
Area Under The Curve ◽  
Al Amyloidosis ◽  
Cardiac Troponin T ◽  
Characteristic Analysis ◽  
Precise Diagnosis

Background: Cardiac amyloidosis (CA) is an important differential diagnosis in patients with myocardial hypertrophy. The precise diagnosis of CA requires endomyocardial biopsy to demonstrate amyloid deposition, but this procedure is relatively invasive and cannot be performed routinely. Therefore, it is important to increase pretest probability of CA in patients with myocardial hypertrophy by noninvasive modalities. Because it is well known that cardiac troponin level is elevated in patients with CA, we hypothesized that increased level of cardiac troponin T contributes to diagnosis of CA in patients with myocardial hypertrophy using high sensitive assay (hs-TnT). Methods and Results: Among nonischemic patients with myocardial hypertrophy (interventricular septal thickness≧ 12 mm), hs-TnT level was measured in 28 CA patients (senile systemic amyloidosis: 13, AL amyloidosis: 14, familial amyloidosis: 1) proven amyloidosis pathologically and 29 non-CA patients proven by endomyocardial biopsy. It was significantly higher in CA patients than non-CA patients (0.075 [0.047-0.116] ng/ml vs. 0.013 [0.009-0.019] ng/ml; p<0.001: Figure). Receiver operating characteristic analysis selected 0.030 ng/ml as the best cutoff value of diagnosis for CA, with a sensitivity and specificity of 96% and 93%, respectively and area under the curve of 0.98 (95% confidence interval 0.94 to 1.00, p<0.001). Conclusions: Increased level of hs-TnT (>0.030 ng/ml) is highly suggestive of CA in patients with myocardial hypertrophy. These patients need additional diagnostic approach for CA.

P2729NT-proBNP and high-sensitivity cardiac troponin T to diagnose cardiac amyloidosis

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
V Castiglione ◽  
A Aimo ◽  
A Barison ◽  
D Genovesi ◽  
C Prontera ◽  
...  
Keyword(s):  
Cardiac Troponin ◽  
Cardiac Amyloidosis ◽  
Troponin T ◽  
High Sensitivity ◽  
Left Ventricular ◽  
Clinical Suspicion ◽  
Al Amyloidosis ◽  
Cardiac Troponin T ◽  
Lv Mass ◽  
The Difference

Abstract Background Cardiac amyloidosis (CA) is characterized by the accumulation of misfolded proteins into amyloid fibrils, leading to cardiomyocyte toxicity, extracellular volume expansion and ventricular pseudohypertrophy. As a consequence of such processes, natriuretic peptides and cardiac troponins are chronically elevated in CA and hold significant prognostic value. The diagnostic yield of these biomarkers for CA has never been explored so far. Methods Plasma levels of N-terminal fraction of pro-B-type natriuretic peptide (NT-proBNP) and high-sensitivity cardiac troponin T (hs-cTnT) were measured in 230 patients referred to a tertiary centre with the clinical suspicion of cardiac amyloidosis. The final diagnosis was established according to current protocols, which include clinical, electrocardiographic, biohumoral, instrumental (echocardiography, cardiac magnetic resonance, diphosphonate scintigraphy), and biopsy examinations. Results Patients were aged 79 (interquartile interval 73–83) years and were predominantly males (n=147, 64%). Mean left ventricular (LV) ejection fraction was 55% (48–62%), and mean LV mass indexed was 150 (120–178) g/m2. CA was confirmed in 86 patients (37%), who had either light chain (AL) amyloidosis (n=25, 29%) or transthyretin (ATTR) amyloidosis (n=61, 71%). Alternative diagnoses were hypertensive cardiopathy (n=69, 48%), valvular disease (n=27, 19%), hypertrophic cardiomyopathy (n=18, 13%), or left ventricular hypertrophy with unknown or multifactorial mechanisms. Patients with CA showed higher NT-proBNP (5507 ng/L [2348–10326] vs. 1332 [392–3752], p<0.001) and hs-cTnT (65 ng/L [48–114] vs. 35 [21–52], p<0.001) than those without CA. The area under the curve (AUC) values for NT-proBNP and hs-cTnT were 0.712 and 0.775 respectively (p=0.062 for the difference). The combination of the two biomarkers improved discrimination over NT-proBNP alone (p=0.011), but not over hs-cTnT (p=0.470) (Figure). A NT-proBNP level <600 ng/L or a hs-cTnT level <17 ng/L were optimal for ruling out amyloidosis, with a negative predictive value of 95% in both cases. Patients with AL amyloidosis had higher NT-proBNP and hs-cTnT than those with ATTR (10809 ng/L [6292–17483] vs. 3084 [1841–7624], p=0.014; 130 ng/L [64–211] vs. 61 [48–95], p=0.006). The difference was even more prominent when biomarker levels were normalized for LV mass (NT-proBNP/LV mass, 33.9 ng/L/g [20.4–53.8] vs. 10.0 [5.8–23.5], p=0.002; hs-cTnT/LV mass, 0.48 ng/L/g [0.25–0.71] vs. 0.19 [0.14–0.26], p=0.001). NT-proBNP and hs-cTnT could effectively discriminate patients with AL amyloidosis among subjects with clinical suspicion of CA (AUC values of 0.787 and 0.805 respectively) (Figure). Figure 1 Conclusions Plasma NT-proBNP and hs-cTnT have diagnostic value in patients with suspected CA. In the subgroup with CA, both biomarkers are higher in patients with AL amyloidosis even when normalizing for LV mass, possibly because of a greater cardiotoxic effect of light-chain fibrils.

scholarly journals High-sensitivity cardiac troponin T and NT-proBNP for ruling-in and ruling-out of cardiac amyloidosis

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
V Castiglione ◽  
A Aimo ◽  
C Prontera ◽  
S Masotti ◽  
V Chubuchny ◽  
...  
Keyword(s):  
Negative Predictive Value ◽  
Predictive Value ◽  
Cardiac Troponin ◽  
Cardiac Amyloidosis ◽  
Troponin T ◽  
High Sensitivity ◽  
Al Amyloidosis ◽  
Cardiac Troponin T ◽  
False Negatives ◽  
Rule Out

Abstract Background Cardiac amyloidosis (CA) is caused by the extracellular deposition of misfolded proteins into insoluble amyloid fibrils, the 2 most common forms being transthyretin (ATTR) and immunoglobulin light chain (AL) amyloidosis. Chronic elevation of cardiac troponins and natriuretic peptides is common in CA and predicts worse outcome. The diagnostic yield of biomarkers of cardiac damage for CA has been less investigated. Purpose We aimed to evaluate the ruling-in/out values for the diagnosis of CA of high-sensitivity cardiac troponin T (hs-cTnT) and of N-terminal fraction of pro-B-type natriuretic peptide (NT-proBNP). Methods We studied 275 consecutive patients referred to two tertiary Centers in Italy (n=184) and France (n=91) with the clinical suspicion of CA due to the presence of a plasma cell dyscrasia or an unexplained left ventricular (pseudo)hypertrophy. CA was confirmed by the combination of suggestive features on imaging techniques (echocardiography, cardiac magnetic resonance, diphosphonate scintigraphy) and biopsy examination. All patients underwent a full baseline characterization including hs-cTnT and NT-proBNP. Biomarkers values corresponding to a negative likelihood ratio &lt;0.1 or a positive likelihood ratio &gt;10 were respectively chosen as rule-out and rule-in cut-offs for CA. Results CA was confirmed in 161 (59%) patients, who had either AL amyloidosis (n=96, 60%) or ATTR amyloidosis (n=65, 40%). At time of evaluation, 97 (35%) patients (34 CA vs. 63 controls, p=0.112) were hospitalized for decompensated heart failure. Patients with CA showed higher hs-cTnT (65 ng/L [44–122] vs. 31 [18–42], p&lt;0.001) and NT-proBNP (4260 ng/L [2006–8911] vs. 1199 [468–3357], p&lt;0.001) than those without CA. The area under the curve (AUC) values for hs-cTnT and NT-proBNP were 0.832 and 0.744 respectively (p=0.002 for the difference). The combination of the two biomarkers (AUC=0.836) improved discrimination over NT-proBNP (p=0.004), but not over hs-cTnT (p=0.423). A hs-cTnT value &lt;15 ng/L (sensitivity=100%, negative predictive value=100%, true negatives=13, false negatives=0) and a NT-proBNP &lt;550 ng/L (sensitivity=98%, negative predictive value=89%, true negatives=33, false negatives=4) were selected as rule-out cut-offs. A hs-cTnT level ≥80 ng/L (specificity=96%, positive predictive value=93%, true positives=71, false positives=5) was optimal for ruling in amyloidosis, while no rule-in cut-off could be selected for NT-proBNP. hs-cTnT values of either ≥80 or &lt;15 ng/dL could effectively rule-in/out 89 (32%) patients. Conclusions Plasma hs-cTnT and NT-proBNP have diagnostic value in patients with suspected CA. Stand-alone hs-cTnT levels &lt;15 or ≥80 ng/L may help to exclude or confirm the diagnosis of CA in up to one third of patients undergoing a diagnostic screening for the disease. Figure 1 Funding Acknowledgement Type of funding source: None

Clinical Implications of CA 125 Elevation in Patients with Cardiac Amyloidosis: An Observational Study

2021 ◽  
Author(s):  
Muzheng Li ◽  
Zhijian Wu ◽  
Ilyas Tudahun ◽  
Qiuzhen Lin ◽  
Na Liu ◽  
...  
Keyword(s):  
Overall Survival ◽  
Cardiac Troponin ◽  
Cardiac Amyloidosis ◽  
Troponin T ◽  
Elevated Serum ◽  
Common Finding ◽  
Ca 125 ◽  
Control Group ◽  
Clinical Implications ◽  
Cardiac Troponin T

Abstract Aims: The level of serum carbohydrate antigen 125 (CA 125) elevated is a common finding in patients with cardiac amyloidosis in clinical practice. It is unclear whether CA 125 is correlated with cardiac amyloidosis. The aim of this study was to systematically evaluate the clinical implications of CA 125 elevation in patients with cardiac amyloidosis.Methods and Results: We enrolled 101 patients diagnosed with cardiac amyloidosis at the Second Xiangya Hospital, 41 patients with acute decompensated heart failure (AHF) and 39 patients with multiple myeloma (MM) who were confirmed to have no cardiac amyloidosis served as control group, respectively. In 101 patients with cardiac amyloidosis, 58 (57%) patients had elevated serum CA 125 levels, which the mean age was 61.2 ± 11.4 years. Patients with high CA 125 were more likely to present with polyserositis ( 79.3% vs 60.5%, p = 0.03) , higher levels of hemoglobin (117.22 ± 21.87 g/L vs. 106.07 ± 25.15 g/L, p = 0.01), serum potassium (4.17 ± 0.49 mmol/L vs. 3.98 ± 0.41 mmol/L, p = 0.05), low density lipoprotein-cholesterol (2.98 ± 1.65 mmol/L vs. 2.22 ± 1.10 mmol/L, p = 0.01), and cardiac troponin T (115 pg/mL vs. 59.52 pg/mL, p = 0.005) . The serum CA 125 levels were significantly higher in cardiac amyloidosis than AHF and MM. The median overall survival for patients with elevated and normal serum CA125 were 5 and 20 months, respectively (p = 0.012). According to multivariate Cox hazard analysis, CA 125 (HR 1.002, 95%CI 1.000-1.004, p = 0.020) contributed to all-cause mortality. The time-dependent receiver operating characteristic was used to reflect the accuracy of different biomarkers in predicting overall survival at various time points by the area under the curve (AUC). CA 125 has no worse prediction accuracy than cardiac troponin T, NT-proBNP and LDH according to the AUC.Conclusions: The prevalence of elevated serum CA 125 levels is more than 50% in patients with cardiac amyloidosis. As an independent prognostic predictor, highly serum CA 125 values indicated the lower overall survival and the accuracy of predicting prognosis was not inferior to the other biomarkers.

Increased Mean Platelet Volume in Patients With Acute Coronary Syndromes

2009 ◽  
Vol 133 (9) ◽  
pp. 1441-1443
Author(s):  
Giuseppe Lippi ◽  
Luca Filippozzi ◽  
Gian Luca Salvagno ◽  
Martina Montagnana ◽  
Massimo Franchini ◽  
...  
Keyword(s):  
Cardiovascular Risk ◽  
Mean Platelet Volume ◽  
Cardiac Troponin ◽  
Acute Coronary Syndromes ◽  
Troponin T ◽  
Cardiac Troponin T ◽  
Characteristic Analysis ◽  
Platelet Volume ◽  
Predictive Values ◽  
Coronary Syndromes

Abstract Context.—Despite remarkable progress, the diagnosis of acute coronary syndromes (ACS) is still challenging. Objective.—The mean platelet volume (MPV), a simple and reliable indicator of platelet size that correlates with platelet activation, might be an emerging cardiovascular risk marker and potentially helpful in stratifying cardiovascular risk. Design.—We analyzed MPV values in 2304 adult patients who were consecutively admitted during a 1-year period to the emergency department of the University Hospital of Verona for chest pain suggestive of ACS. In all patients, a baseline blood sample was collected for routine hematologic testing, whereas cardiac troponin T measurements were collected both at baseline and after 4, 6, and 12 hours. Results.—A total of 456 patients (19.8% of total) had ACS. These patients, all having cardiac troponin T levels of 0.03 ng/mL or greater in addition to ischemic electrocardiographic changes, had higher MPV values than non-ACS patients with normal cardiac troponin T levels (median, 8.0 fL [5th to 95th percentiles, 6.7–10.0 fL] versus median, 7.4 fL [5th to 95th percentiles, 6.5–9.5 fL]; P &lt; .001). The diagnostic accuracy of MPV, calculated as the area under the curve by the receiver operating characteristic analysis, was 0.661 (P &lt; .001). At the 9.0-fL cutoff, the negative and positive predictive values of MPV were 83% and 43%, respectively. Conclusions.—Because MPV is a simple and inexpensive laboratory measurement, it might be considered a useful rule-out test along with other conventional cardiac biomarkers for the risk stratification of ACS patients admitted to the emergency departments.

scholarly journals Serum Cardiac Troponin T in Cardiac Amyloidosis: Serial Observations in Five Patients

2006 ◽  
Vol 208 (2) ◽  
pp. 163-167 ◽  
Author(s):  
Takao Kato ◽  
Yukihito Sato ◽  
Kazuya Nagao ◽  
Takahiro Horie ◽  
Kazuaki Kataoka ◽  
...  
Keyword(s):  
Cardiac Troponin ◽  
Cardiac Amyloidosis ◽  
Troponin T ◽  
Cardiac Troponin T ◽  
Serum Cardiac Troponin

scholarly journals Diagnostic utility of cardiac troponin T level in patients with cardiac amyloidosis

2017 ◽  
Vol 5 (1) ◽  
pp. 27-35 ◽  
Author(s):  
Seiji Takashio ◽  
Megumi Yamamuro ◽  
Yasuhiro Izumiya ◽  
Kyoko Hirakawa ◽  
Kyohei Marume ◽  
...  
Keyword(s):  
Cardiac Troponin ◽  
Cardiac Amyloidosis ◽  
Troponin T ◽  
Cardiac Troponin T ◽  
Diagnostic Utility

scholarly journals Predictors of cardiac involvement and survival in patients with primary systemic light-chain amyloidosis: roles of the clinical, chemical, and 3-D speckle tracking echocardiography parameters

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Changhui Lei ◽  
Xiaoli Zhu ◽  
David H. Hsi ◽  
Jing Wang ◽  
Lei Zuo ◽  
...  
Keyword(s):  
Light Chain ◽  
Cardiac Troponin ◽  
Speckle Tracking ◽  
Cardiac Involvement ◽  
Speckle Tracking Echocardiography ◽  
Troponin T ◽  
Al Amyloidosis ◽  
Cardiac Troponin T ◽  
3D Measurements ◽  
Staging Systems

Abstract Background Light-chain (AL) amyloidosis is the most common type of systemic amyloidosis with poor prognosis. Currently, the predictors of cardiac involvement and prognostic staging systems are primarily based on conventional echocardiography and serological biomarkers. We used three-dimensional speckle tracking echocardiography (STE-3D) measurements of strain, hypothesizing that it could detect cardiac involvement and aid in prediction of mortality. Methods We retrospectively analysed 74 consecutive patients with biopsy-proven AL amyloidosis. Among them, 42 showed possible cardiac involvement and 32 without cardiac involvement. LV global longitudinal strain (GLS), global radial strain, global circumferential strain and global area strain (GAS) measurements were obtained. Results The GLS and GAS were considered significant predictors of cardiac involvement. The cut-off values discriminating cardiac involvement were 16.10% for GLS, 32.95% for GAS. During the median follow-up of 12.5 months (interquartile range 4–25 months), 20 (27%) patients died. For the Cox proportional model survival analysis, heart rate, cardiac troponin T, NT-proBNP levels, E/e’, GLS, and GAS were univariate predictors of death. Multivariate Cox model showed that GLS ≤ 14.78% and cardiac troponin T ≥ 0.049 mg/l levels were independent predictors of survival. Conclusions STE-3D measurements of LV myocardial mechanics could detect cardiac involvement in patients with AL amyloidosis; GLS and cardiac biomarkers can provided prognostic information for mortality prediction.

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