High T2-weighted signal intensity is associated with elevated troponin T in hypertrophic cardiomyopathy

Gommans, DH Frank; Cramer, G. Etienne; Bakker, Jeannette; Michels, Michelle; Dieker, Hendrik-Jan; Timmermans, Janneke; Fouraux, Michael A.; Marcelis, Carlo; Verheugt, Freek W.A.; Brouwer, Marc A.; Kofflard, Marcel

doi:10.1136/heartjnl-2016-309900

Cited by 19 publications

(37 citation statements)

References 30 publications

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“…There is limited information about the factors that contribute to troponin release in this particular group of patients. Troponin concentrations have been related to left ventricular (LV) mass and the presence of imaging signs of myocardial injury 2–5. Importantly, it is widely appreciated that the hypertrophic phenotype in HCM is related to pathophysiological abnormalities in vasculature, myocardial structure and function,6 7 which may all contribute to the occurrence of myocardial ischaemia 8 9.…”

Section: Introductionmentioning

confidence: 99%

“…Cardiac magnetic resonance imaging (CMRi) studies have correlated areas of ischaemia with segmental late gadolinium enhancement (LGE) and high signal intensity on T2-weighted imaging (HighT2) 10–12. HighT2 has been demonstrated to be strongly associated with elevated troponin in HCM and is considered to represent an active state of disease 4 13…”

Section: Introductionmentioning

confidence: 99%

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Exercise and myocardial injury in hypertrophic cardiomyopathy

Cramer

Gommans

Dieker

et al. 2020

Heart

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ObjectiveTroponin and high signal intensity on T2-weighted (HighT2) cardiovascular magnetic resonance imaging (CMRi) are both markers of myocardial injury in hypertrophic cardiomyopathy (HCM). The interplay between exercise and disease development remains uncertain in HCM. We sought to assess the occurrence of postexercise troponin rises and its determinants.MethodsMulticentre project on patients with HCM and mutation carriers without hypertrophy (controls). Participants performed a symptom limited bicycle test with hs-cTnT assessment pre-exercise and 6 hours postexercise. Pre-exercise CMRi was performed in patients with HCM to assess measures of hypertrophy and myocardial injury. Depending on baseline troponin (< or >13 ng/L), a rise was defined as a >50% or >20% increase, respectively.ResultsTroponin rises occurred in 18% (23/127) of patients with HCM and 4% (2/53) in mutation carriers (p=0.01). Comparing patients with HCM with and without a postexercise troponin rise, maximum heart rates (157±19 vs 143±23, p=0.004) and maximal wall thickness (20 mm vs 17 mm, p=0.023) were higher in the former, as was the presence of late gadolinium enhancement (85% vs 57%, p=0.02). HighT2 was seen in 65% (13/20) and 19% (15/79), respectively (p<0.001). HighT2 was the only independent predictor of troponin rise (adjusted odds ratio 7.9; 95% CI 2.7 to 23.3; p<0.001).ConclusionsPostexercise troponin rises were seen in about 20% of patients with HCM, almost five times more frequent than in mutation carriers. HighT2 on CMRi may identify a group of particularly vulnerable patients, supporting the concept that HighT2 reflects an active disease state, prone to additional injury after a short episode of high oxygen demand.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Exercise and myocardial injury in hypertrophic cardiomyopathy

Cramer

Gommans

Dieker

et al. 2020

Heart

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“…For the present analysis, 98 nonhigh HC patients selected from our total HC cohort of 141 HC patients were studied (61% male, age 55 § 14 years) ( Figure 1 and Table 1). 20 Most patients were a-or mildly symptomatic with 96 (98%) in New York Heart Association class I to II. The presence of LGE was demonstrated in 56 (57%) patients.…”

Section: Resultsmentioning

confidence: 98%

“…For this analysis, we selected nonhigh risk patients from a large cohort of HC patients who participated in a Dutch multicenter study on CMR imaging and biomarkers. 20 In short, adult HC patients from different hospitals were enrolled at 2 outpatient clinics (Radboud University Medical Center, Nijmegen and Albert Schweitzer Hospital, Dordrecht, The Netherlands) from 2008 to 2014. Patients had to fulfill the diagnostic criteria for HC according to the prevailing guidelines at the time of inclusion and should not have a history of coronary artery disease or septal reduction therapy.…”

Section: Methodsmentioning

confidence: 99%

Prediction of Extensive Myocardial Fibrosis in Nonhigh Risk Patients With Hypertrophic Cardiomyopathy

Gommans

Cramer

Fouraux

et al. 2018

The American Journal of Cardiology

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In nonhigh risk patients with hypertrophic cardiomyopathy (HC), the presence of extensive late gadolinium enhancement (LGE) at cardiovascular magnetic resonance (CMR) imaging has been proposed as a risk modifier in the decision process for implantable cardioverter defibrillator implantation. With a pretest risk of about 10%, a strategy that alters the likelihood of LGE could markedly affect efficacious CMR imaging. Our aim was to study the potential of clinical variables and biomarkers to predict LGE. In 98 HC patients without any clear indication for implantable cardioverter defibrillator implantation, we determined the discriminative values of a set of clinical variables and a panel of biomarkers (hs-cTnT, NTproBNP, GDF-15, and Gal-3, CICP) for LGE, that is, LGE ≥15% of the left ventricular mass. LGE was present in 10% (10/98) of patients. The clinical prediction model contained a history of nonsustained ventricular tachycardia, maximal wall thickness and reduced systolic function (c-statistic: 0.868, p <0.001). Of all biomarkers, only hs-cTnT was associated with LGE, in addition to the improved clinical model of diagnostic accuracy (p = 0.04). A biomarker-only strategy allowed the exclusion of LGE in half of the cohort, in case of a hs-cTnT concentration less than the optimal cutoff (Youden index; 8 ng/L-sensitivity 100%, specificity 54%). In conclusion, in this nonhigh risk HC cohort, the pretest likelihood of LGE can be altered using clinical variables and the addition of hs-cTnT. The promising findings with the use of hs-cTnT only call for new initiatives to study its impact on efficacious CMR imaging in a larger HC population, either with or without additional use of clinical variables.

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“…48,49 A high T2 signal on CMR, a potential marker of active tissue injury, in HCM is also associated with elevated troponin levels. 50 Prognosis: patients with HCM and elevated TnI have significantly more CV events (HCMrelated death or hospitalisation, embolic strokes, or the appearance of sustained ventricular tachycardia) than those with normal TnI over a follow-up period of 39 months. 51 An adverse prognosis has also been demonstrated using a hs-TnT assay in two independent study cohorts.…”

Section: Familial Cardiomyopathy Tnnt2 Tnni3 Tnnc1mentioning

confidence: 99%

Measurement of Troponin in Cardiomyopathies

2016

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Troponins are thin myofilament proteins that regulate the contraction of cardiac and skeletal muscle. The cardio-specific troponin I (TnI) and T (TnT) proteins are sensitive and specific biomarkers of myocardial injury which over the past twenty years have revolutionised the diagnosis and management of myocardial infarction. With the advent of high sensitivity assays the role for cardiac troponins is possibly expanding. Elevated levels are associated with adverse cardiovascular events and mortality in heart failure and the general population. Studies in cardiomyopathies are generally small with <200 patients, but serum troponin levels can be chronically raised and detect subclinical myocyte damage. This review examines all major published studies of cardiac troponin measurement in cardiomyopathies. There is considerable variability among studies regarding assays used and definitions of abnormal results but elevated troponin levels are almost invariably related to poor prognosis and their negative predictive value is important.

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High T2-weighted signal intensity is associated with elevated troponin T in hypertrophic cardiomyopathy

Cited by 19 publications

References 30 publications

Exercise and myocardial injury in hypertrophic cardiomyopathy

Exercise and myocardial injury in hypertrophic cardiomyopathy

Prediction of Extensive Myocardial Fibrosis in Nonhigh Risk Patients With Hypertrophic Cardiomyopathy

Measurement of Troponin in Cardiomyopathies

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