Troponin as ischemic biomarker is related with all three echocardiographic risk factors for sudden death in hypertrophic cardiomyopathy (ESC Guidelines 2014)

Abstract

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.

Painful and painless myocardial ischemia detected by elevated level of high-sensitive troponin in patients with hypertrophic cardiomyopathy

“…A group of 100 consecutive patients with HCM, both from ambulatory care and admitted to the clinic due to cardiac signs and symptoms (pooled group), were recruited to the study. Patients from our previous ambulatory studies were included in the current study; however, the present investigation is different from the previous one [ 3 , 4 ] and is based on the history of angina pectoris within 24 h before the hs-TnI measurement. We attempted to investigate a full spectrum of patients from asymptomatic ones to those with severe symptoms requiring hospitalization.…”

“…High-sensitivity troponin I (hs-TnI), an extra-precise biomarker for the detection of even small myocardial injury caused by ischemia, has been successfully used in patients with hypertrophic cardiomyopathy (HCM) [ 1 , 2 ]. In the most recent studies [ 3 , 4 ], measurements of hs-TnI levels were synchronized with a noninvasive assessment of hemodynamic parameters in the following way: first, resting echocardiography (including a provocative maneuver to induce a left ventricular outflow tract (LVOT) gradient) was performed, followed by ambulatory electrocardiography (ECG) Holter monitoring with devices which allow potential episodes of angina pectoris to be marked by the patients. After the 24-hour ECG Holter monitoring in conditions of typical everyday physical activity, the measurement of hs-TnI level was immediately performed.…”

“…After the 24-hour ECG Holter monitoring in conditions of typical everyday physical activity, the measurement of hs-TnI level was immediately performed. Interestingly, the biomarker level had a close time relationship with findings on Holter monitoring [ 3 ] and echocardiography [ 4 ].…”

“…High-sensitivity troponin I levels were associated with both an increased heart rate during Holter monitoring [ 3 ] and a provoked LVOT gradient [ 4 ] (stimuli provoking myocardial ischemia). These findings are corroborated by previous studies in invasive and nonphysiological, atrial pacing stressors [ 5 – 7 ].…”

Anginal pain and elevated troponin level despite normal coronary angiography: hypertrophic cardiomyopathy with severe obstruction due to vasodilator/diuretic therapy for coincident arterial hypertension

“…This suggests that an increased LVOT gradient may be partially responsible for myocardial ischemia (apart from tachycardia diagnosed to be responsible for hs-TnI release in hypertrophic cardiomyopathy) [ 1 , 2 ]. In a previous report, HCM patients with elevated hs-TnI levels (positive hs-TnI test) had higher values of both resting and provoked LVOT gradient [ 3 ]. However, this analysis was based only on one measurement of LVOT gradient and hs-TnI synchronized in a 24-hour period.…”