Elevated troponin and abnormalities of cardiac structure and function in AL cardiac amyloidosis
e19524 Background: Patients with systemic amyloidosis involving the heart have generally a poor prognosis. Elevated cardiac troponin (cTn) has been shown to predict poor survival in patients with AL cardiac amyloidosis (CA). However, cardiac structure and function associated with an elevated cTn in patients with CA remains uncertain. Methods: Eighty patients with CA who had an echocardiogram and cTnI measured at the time of diagnosis between March 1997 May 2008 were included in the study. The patients were divided into 2 groups: normal cTnI ( <0.06 ng/ml, n = 28) or elevated cTnI (≥0.06 ng/ml; n = 52). Results: The elevated cTnI group was slightly older with higher brain natriuretic peptide (BNP) level and creatinine clearance than the normal cTnI group. There was a trend towards higher prevalence of congestive heart failure (CHF) in the elevated cTnI group than the normal group at time of diagnosis. The elevated cTnIgroup had thicker interventricular septum and higher left atrial (LA) volume than the normal group. LV ejection fraction, left atrial systolic force (LASF) and stroke volume were lower in the elevated cTnI group than the normal group. Mean survival was significantly shorter in the elevated cTnI group than the normal group (10 vs. 47 months). Conclusions: Elevated troponin in patients with AL cardiac amyloidosis is associated with worse left atrial and ventricular structure and function. The raised troponin level reflects myocardial injury due to the amyloid deposition and correlates with more abnormal alteration of cardiac structure and function. Routine measurement of troponin is useful in identifying high risk patients with CA. [Table: see text] No significant financial relationships to disclose.