BackgroundSudden cardiac death (SCD) risk stratification is the most important preventive action in patients with hypertrophic cardiomyopathy (HCM). The identification of the ischemia biomarker high sensitive troponin I (hs-TnI) role for this arrhythmic disease may provide additional information for SCD risk stratification. The aim of the study was to compare echocardiographic parameters (prognostic for risk stratification of SCD in HCM) among two subgroups of HCM patients: with elevated hs-TnI versus non-elevated hs-TnI level.MethodsIn 51 HCM patients (mean age 39 ± 8 years, 31 males and 20 females) an echocardiographic examination, including the stimulating maneuvers to provoke maximized LVOT gradient, was performed. The hs-TnI was measured 24 h later.ResultsBy comparing two subgroups of patients, 26 members with hs-TnI positive versus 25 with hs-TnI negative, the study showed that the values of all three parameters were greater: provocable left ventricular outflow tract gradient (LVOTG) – 49.1 ± 45.9 vs 25.5 ± 24.8 mmHg, p = 0.019; left atrial diameter – 50.1 ± 9.6 vs 43.9 ± 9.8 mmHg, p = 0.041; maximal LV thickness – 22.1 ± 5.3 vs 19.9 ± 34 mm, p = 0.029.ConclusionThe increased value of all three echocardiographic parameters used as risk factors for SCD (ESC Guidelines) is related to the elevated level of hs-TnI in HCM. Due to the high LVOTG – great hs-TnI relationship, exercise stress, both diagnostic and even rehabilitation/training, should be monitored by biomarker control.

The aim of this study was to assess the relationship between biomarkers (high-sensitive troponin I [hs-TnI], N-Terminal probrain natriuretic peptide [NT-proBNP]) and calculated 5-year percentage risk score of sudden cardiac death (SCD) in hypertrophic cardiomyopathy (HCM). Methods. In 46 HCM patients (mean age 39 ± 7 years, 24 males and 22 females), echocardiographic examination, including the stimulating maneuvers to provoke maximized LVOT gradient, had been performed and next ECG Holter was immediately started. After 24 hours, the ECG Holter was finished and the hs-TnI and NT-proBNP have been measured. Patients were divided according to 1/value of both biomarkers (hs-TnI-positive and hs-TnI-negative subgroups) and 2/(NT-proBNP lower and higher subgroup divided by median). Results. In comparison between 19 patients (hs-TnI positive) versus 27 patients (hs-TnI negative), the calculated 5-year percentage risk of SCD in HCM was significantly greater (6.38 ± 4.17% versus 3.81 ± 3.23%, P < 0.05). In comparison between higher NT-proBNP versus lower NT-proBNP subgroups, the calculated 5-year percentage risk of SCD in HCM was not significantly greater (5.18 ± 3.63% versus 4.14 ± 4.18%, P > 0.05). Conclusions. Patients with HCM and positive hs-TnI test have a higher risk of SCD estimated according to SCD calculator recommended by the ESC Guidelines 2014 than patients with negative hs-TnI test.

RESEARCH LETTER Elevated troponin level in hypertrophic cardiomyopathy 445probably a common finding during normal everyday physical activity. In particular, we suspect that elevated hs -TnI levels (the high -sensitivity method being particularly useful) are quite common during the daily activities of patients with HCM (even on pharmacotherapy). However, this phenomenon may be underdiagnosed or completely unrecognized. Therefore, we decided to investigate the presence of and potential mechanism underlying the increased hs -TnI levels in relation to findings on Holter monitoring.Patients and methods Consecutive patients with HCM, treated and monitored at our clinic, were recruited to the study. Most patients received pharmacotherapy (TABLE 1) and underwent regular medical check -ups as part of ambulatory care.The exclusion criteria were as follows: ST--segment or non -ST -segment elevation myocardial infarction (recent or previous), significant coronary stenosis on coronary angiography, or renal failure. The final sample included 32 patients with HCM (mean [SD] age, 40 [11] years; 20 men and 12 women).According to the study protocol, echocardiography was performed first. Immediately after the echocardiography, a 24 -hour ECG test was started to assess possible tachycardia episodes as a potential trigger of hs -TnI release. Moreover, we searched for possible episodes of nonsustained ventricular tachycardia (NSVT, a risk factor for sudden cardiac death according to the European Society of Cardiology and American Heart Association / American College of Cardiology guidelines) as a potential result of ischemia detected by hs -TnI release. The hs -TnI level was assessed Introduction High -sensitive troponin I (hs -TnI), an ultraprecise biomarker for the detection of myocardial ischemia, has been investigated in patients with hypertrophic cardiomyopathy (HCM) in several studies. 1-4 However, troponin levels were measured only at a resting state and were not synchronized in time with ambulatory electrocardiography (ECG) monitoring (Holter monitoring). So far, no studies have used the following protocol: 24 -hour Holter monitoring first and then the measurement of hs -TnI (the biomarker level has a close temporal relationship with findings on Holter monitoring). This protocol seems to be reasonable because hs -TnI levels may be both associated with increased heart rate (potential cause of myocardial ischemia) and be a potential cause of life -threatening ventricular arrhythmias occurring during the previous 24 hours.As regards the dynamic stress test (under natural conditions and related to a single episode of rapidly increased heart rate) in adults with HCM, there have been only 2 reports of troponin measurement (without the use of high -sensitivity method): one taken after an episode of rapid supraventricular tachycardia in a natural everyday situation, 5 and the other after a physician--controlled exercise stress test. 6 The exercise stress test was performed in a small group of 7 patients, 5 of whom revealed elevated...

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