title: Clinical and echocardiographic correlates of elevated troponin in amyloid light-chain cardiac amyloidosis.
abstract: Increased troponin is associated with poor survival in patients with amyloid light-chain (AL) amyloidosis with cardiac involvement (CAL). The purpose of this investigation was to define the relation between increased troponin and clinical, morphologic, and functional features. The comparative utility of clinical, echocardiographic, and biochemical measurements in predicting survival in CAL was also investigated. One hundred seventeen patients with CAL were divided into 2 groups: normal troponin I (<0.06 ng/ml, n = 42) or increased troponin I (≥0.06 ng/ml, n = 75). Patients in the high troponin I group were older (63 vs 58 years, p = 0.04), with higher B-type natriuretic peptide levels (1,417 vs 936 pg/ml, p = 0.0004). The high troponin I group also had higher echocardiography-determined early/late mitral inflow velocity ratio (2.2 vs 1.4, p = 0.005) and myocardial performance index (0.59 vs 0.45, p = 0.04) and lower stroke index (28 vs 38 ml/beat/m(2), p <0.0001) and left atrial systolic force (5.9 vs 8.4 k-dynes, p = 0.037) than the normal troponin group. Median survival was significantly shorter in the high troponin group (11 vs 45 months, p <0.001). At time of CAL diagnosis, univariate predictors of all-cause mortality included increased troponin, older age, male gender, New York Heart Association class III to IV, >2 organs involved, higher B-type natriuretic peptide, lower creatinine clearance, greater ventricular septal thickness, and higher myocardial performance index. However, by multivariate Cox survival analysis, only increased troponin was a significant predictor for all-cause mortality (hazard ratio 3.1, p = 0.002). In conclusion, increased troponin is associated with worse left ventricular and left atrial functions by echocardiography in patients with CAL. Among baseline variables, it is the strongest predictor of all-cause mortality in multivariate analysis. Troponin is a powerful tool in clinical and prognostic assessments of patients with CAL.
authors: Memorial Sloan-Kettering Cancer Center, New York, New York, USA.
authors: Teimuraz
authors: T
authors: Apridonidze
authors: Richard M
authors: RM
authors: Steingart
authors: Raymond L
authors: RL
authors: Comenzo
authors: James
authors: J
authors: Hoffman
authors: Yuliya
authors: Y
authors: Goldsmith
authors: Jonathan N
authors: JN
authors: Bella
authors: Heather
authors: H
authors: Landau
authors: Jennifer E
authors: JE
authors: Liu
mesh_terms: D000368:Aged; D000686:Amyloidosis / Q000150:complications*; D015415:Biomarkers / Q000097:blood; D001706:Biopsy; D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000209:etiology*; D016009:Chi-Square Distribution; D015150:Echocardiography, Doppler; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D016016:Proportional Hazards Models; D015996:Survival Rate; D014336:Troponin / Q000097:blood
chemical_list: D015415:Biomarkers; D014336:Troponin; D020097:Natriuretic Peptide, Brain