title: Detectable serum cardiac troponin T as a marker of poor prognosis among patients with chronic precapillary pulmonary hypertension.
abstract: BACKGROUND
  Right ventricular failure is a leading cause of death in patients with chronic pulmonary hypertension (PH). We checked whether detection of cardiac troponin T (cTnT), a specific marker of myocyte injury, could be useful in prognostic stratification of those patients.
  
  
  RESULTS
  Initial evaluation of 56 clinically stable patients (age 41+/-15 years) with pulmonary arterial (51 patients) or inoperable chronic thromboembolic (5 patients) PH (mean pulmonary arterial pressure 60+/-18 mm Hg) included cTnT test, allowing detection of its serum levels > or =0.01 ng/mL [cTnT(+)]. cTnT was detectable in 8 of 56 (14%) patients (mean+/-SD, 0.034+/-0.022; range, 0.010 to 0.077 ng/mL). Despite similar pulmonary hemodynamics, they had higher heart rate (92+/-15 versus 76+/-14 bpm, P=0.004), lower mixed venous oxygen saturation (50+/-10% versus 57+/-9%, P=0.04), and higher serum N-terminal pro-B-type natriuretic peptide (4528+/-3170 versus 2054+/-2168 pg/mL, P=0.03) and walked less during the 6-minute walk test (298+/-132 versus 396+/-101 m, P=0.02). Cumulative survival estimated by Kaplan-Meier curves was significantly worse at 24 months in cTnT(+) compared with cTnT(-) (29% versus 81%, respectively, log-rank test P=0.001). Multivariate analysis revealed cTnT status (hazard ratio, 4.89; 95% CI, 1.18 to 20.29; P=0.03), 6-minute walk test (hazard ratio, 0.93 for each 10 m; P=0.01), and pulmonary vascular resistance (hazard ratio, 1.13; P=0.01) as independent markers of mortality. All 3 cTnT(+) patients who survived the follow-up period converted to cTnT(-) during treatment.
  
  
  CONCLUSIONS
  Detectable cTnT is a so-far ignored independent marker of increased mortality risk in patients with chronic precapillary PH, supporting the role of progressive myocyte injury in the vicious circle leading to hemodynamic destabilization.
authors.affiliation: Department of Chest Medicine, Institute of Tuberculosis and Lung Diseases, Medical University of Warsaw, Poland. torbi@pol.pl
authors.forename: Adam
authors.initials: A
authors.lastname: Torbicki
authors.forename: Marcin
authors.initials: M
authors.lastname: Kurzyna
authors.forename: Paweł
authors.initials: P
authors.lastname: Kuca
authors.forename: Anna
authors.initials: A
authors.lastname: Fijałkowska
authors.forename: Jarosław
authors.initials: J
authors.lastname: Sikora
authors.forename: Michał
authors.initials: M
authors.lastname: Florczyk
authors.forename: Piotr
authors.initials: P
authors.lastname: Pruszczyk
authors.forename: Janusz
authors.initials: J
authors.lastname: Burakowski
authors.forename: Lilianna
authors.initials: L
authors.lastname: Wawrzyńska
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D002196:Capillaries / Q000503:physiopathology*; D002908:Chronic Disease; D018450:Disease Progression; D004452:Echocardiography; D017079:Exercise Tolerance; D005260:Female; D005500:Follow-Up Studies; D006439:Hemodynamics; D006801:Humans; D006976:Hypertension, Pulmonary / Q000097:blood* / Q000175:diagnosis* / Q000503:physiopathology; D008168:Lung / Q000098:blood supply*; D008297:Male; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D015203:Reproducibility of Results; D015996:Survival Rate; D020107:Troponin T / Q000097:blood*
chemical_list: D015415:Biomarkers; D020107:Troponin T