Cardiac Troponin T Measured With a Highly Sensitive Assay for Diagnosis and Monitoring of Heart Injury in Chronic Chagas Disease

Abstract

Context.—Chronic Chagas disease (15 million patients; annual incidence, 40 000 patients; annual mortality, 12 500 patients) is the most serious parasitic disease in Latin America. Between 10 and 30 years after infection, 30% of patients with Chagas disease develop heart injury, which is the main reason for its high mortality. Consequently, frequent cardiac diagnostics are required for patients with Chagas disease. Objective.—To minimize time-intensive and cost-intensive diagnostics, such as electrocardiography, echocardiography, and radiologic imaging, we tested the effect of measuring serum cardiac troponin T (cTnT) with a highly sensitive assay. To indicate the pathophysiologic background for cTnT release in Chagas heart injury, inflammation markers, such as C-reactive protein and interleukin 6, were measured in parallel. Design.—Serum cTnT was measured in 26 healthy subjects and in 179 patients with chronic Chagas disease who were asymptomatic (indeterminate stage, n = 86), who were suffering from cardiomyopathy with or without megacolon (n = 71), or who were suffering from megacolon exclusively (n = 22). Results.—Serum cTnT was significantly higher in patients with cardiomyopathy with or without megacolon than in healthy subjects, asymptomatic subjects, and patients with megacolon, and the cTnT value was correlated with the severity of the cardiomyopathy. The lower limit of detection for the highly sensitive assay (3 ng/L) was best at distinguishing patients with, and without, heart injury. C-reactive protein and interleukin 6 were found to parallel cTnT changes in both the different Chagas groups and the cardiomyopathy groups separated by disease severity. Conclusions.—Highly sensitive cTnT measurement has the potential to contribute to diagnosis and monitoring of heart injury in patients with chronic Chagas disease. The highly sensitive assay of cTnT release seems to be related to Chagas heart disease–specific inflammation.

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“…these results in a study that analyzed the prognostic value of BNP, NT-proBNP, creatine kinase-myocardial band (CK-MB), troponin I, matrix metalloproteinase (MMP-2), MMP-9, and tissue inhibitor of metalloproteinases (TIMP) 1 and 2 in a group of 50 T. cruzi-infected Stage D Bolivian patients. In this study, higher baseline levels of BNP, NT-proBNP, CK-MB, and MMP-2 were significantly associated with increased mortality at 14 months [14]. Interestingly, in our study dichotomic Hs-cTnT had a similar prognostic value when compared to NT-proBNP and Hs-cTnT combination, a finding that may improve the assessment of CCM patients in low-resource settings, in which Hs-cTnT may be cheaper and more easily performed.…”

“…However, the experience regarding biomarkers use in CD has shown that numerous challenges still remain to allow optimal use and reliably estimate the risk of CCM progression [10,11]. Moreover, while several serum biomarkers have been identified as having a significant diagnostic and prognostic value in heart failure (HF) of other etiologies, few studies have addressed their role in CCM, which, given its unique pathogenesis, warrants direct confirmation [12][13][14].…”

Cardiovascular biomarkers as predictors of adverse outcomes in chronic Chagas cardiomyopathy

“…cruzi -infected Stage D Bolivian patients. In this study, higher baseline levels of BNP, NT-proBNP, CK-MB, and MMP-2 were significantly associated with increased mortality at 14 months [ 14 ]. Interestingly, in our study dichotomic Hs-cTnT had a similar prognostic value when compared to NT-proBNP and Hs-cTnT combination, a finding that may improve the assessment of CCM patients in low-resource settings, in which Hs-cTnT may be cheaper and more easily performed.…”

“…However, the experience regarding biomarkers use in CD has shown that numerous challenges still remain to allow optimal use and reliably estimate the risk of CCM progression [ 10 , 11 ]. Moreover, while several serum biomarkers have been identified as having a significant diagnostic and prognostic value in heart failure (HF) of other etiologies, few studies have addressed their role in CCM, which, given its unique pathogenesis, warrants direct confirmation [ 12 – 14 ].…”

Circulating DHEA-S levels and major cardiovascular outcomes in chronic Chagas cardiomyopathy: A prospective cohort study

“…A relatively under-explored option for risk prediction in CD cardiomyopathy that may prove very useful in this context are serum biomarkers [7]. Nevertheless, few studies have addressed their role in CCM, which warrants direct confirmation given its unique pathogenesis [8][9][10][11].…”