Congenital heart disease · 2012
High-sensitivity troponin T is associated with poor outcome in adults with pulmonary arterial hypertension due to congenital heart disease.
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Schuuring Mark J, van Riel Annelieke C M J, Vis Jeroen C, Duffels Marielle G, van Straalen Jan P, Boekholdt S Matthijs, Tijssen Jan G P, Mulder Barbara J M, Bouma Berto J
Аннотация
OBJECTIVE: Pulmonary arterial hypertension due to congenital heart disease (CHD-PAH) has a poor prognosis. We sought to determine whether the biomarker high-sensitivity troponin T (hsTnT) measured on routine visit at the outpatient clinic is associated with prognosis.
PATIENTS: Consecutive adult CHD-PAH (86% Eisenmenger syndrome) patients referred for advanced medical therapy between January 2005 and March 2007 in the Academic Medical Center in Amsterdam. Patients with severe renal impairment were excluded.
MAIN OUTCOME MEASURE: The primary outcome was mortality.
RESULTS: Of all 31 patients (mean age 45 ± 12 years) with CHD-PAH, eight patients died during a median follow-up of 5.6 (range 1.6 to 6.8) years. A hsTnT level >0.014 μg/L was the 99th percentile cutoff of the normal distribution and therefore defined as elevated. At baseline, elevated levels of hsTnT were found in eight patients (26%). In univariate Cox regression, hsTnT elevated at baseline, NT-pro-BNP and right ventricular function were determinants of death (P < .05 for all). Patients with elevated levels of hsTnT showed a significantly higher mortality rate as compared to patients with normal hsTnT levels (62% vs. 13%, P = .005).
CONCLUSION: Levels of hsTnT were abnormal in a substantial proportion of CHD-PAH patients. A significant inverse relationship was found between hsTnT and survival.
PATIENTS: Consecutive adult CHD-PAH (86% Eisenmenger syndrome) patients referred for advanced medical therapy between January 2005 and March 2007 in the Academic Medical Center in Amsterdam. Patients with severe renal impairment were excluded.
MAIN OUTCOME MEASURE: The primary outcome was mortality.
RESULTS: Of all 31 patients (mean age 45 ± 12 years) with CHD-PAH, eight patients died during a median follow-up of 5.6 (range 1.6 to 6.8) years. A hsTnT level >0.014 μg/L was the 99th percentile cutoff of the normal distribution and therefore defined as elevated. At baseline, elevated levels of hsTnT were found in eight patients (26%). In univariate Cox regression, hsTnT elevated at baseline, NT-pro-BNP and right ventricular function were determinants of death (P < .05 for all). Patients with elevated levels of hsTnT showed a significantly higher mortality rate as compared to patients with normal hsTnT levels (62% vs. 13%, P = .005).
CONCLUSION: Levels of hsTnT were abnormal in a substantial proportion of CHD-PAH patients. A significant inverse relationship was found between hsTnT and survival.
Предметные рубрики MeSH
Academic Medical CentersAdultBiomarkersChi-Square DistributionEisenmenger ComplexFamilial Primary Pulmonary HypertensionFemaleHumansHypertension, PulmonaryKaplan-Meier EstimateMaleMiddle AgedNatriuretic Peptide, BrainNetherlandsPeptide FragmentsPredictive Value of TestsPrognosisProportional Hazards ModelsRisk FactorsTime FactorsTroponin TUp-RegulationVentricular Function, Right