title: High sensitivity cardiac troponin T in patients with immunoglobulin light chain amyloidosis.
abstract: OBJECTIVE
  To define whether the high sensitivity cardiac troponin T (hs-cTnT) assay in patients with immunoglobulin light chain amyloidosis (AL) improves risk prediction.
  
  
  BACKGROUND
  Cardiac involvement is the major cause of death in patients with AL amyloidosis. Risk stratification is facilitated by cardiac biomarkers such as cardiac troponin T (cTnT) and N-terminal pro B-type natriuretic peptide (NT-proBNP).
  
  
  METHODS
  Stored serum from patients with newly diagnosed AL was used to measure hs-cTnT, cTnT, and NT-proBNP. Survival modelling was performed.
  
  
  RESULTS
  The direct numeric result from hs-cTnT measurement cannot merely be substituted for a cTnT measurement in the Mayo AL staging system. The performance of the receiver operator curve derived an hs-cTnT cut-point of 54 ng/L which improves on the value of 35 ng/L validated with the prior iteration of the assay. An alternate staging option using hs-cTnT alone-using the two thresholds 14 ng/L and 54 ng/L-performs as well as either the original Mayo AL staging system or other systems incorporating hs-cTnT. On multivariate analysis, an hs-cTnT alone staging system was independent of period of diagnosis, type of therapy, and NT-proBNP value, the last of which dropped out of the model. Alternate models were explored, but none performed better than the original system or the new hs-cTnT system. Thus, hs-cTnT can be used alone for the staging of disease prognosis.
  
  
  CONCLUSIONS
  A survival model based on hs-cTnT improves the prognostic staging of patients with AL amyloidosis, relegating NT-proBNP to a measure of cardiac response.
authors.affiliation: Division of Hematology and Internal Medicine, Mayo Clinic, , Rochester, Minnesota, USA.
authors.forename: A
authors.initials: A
authors.lastname: Dispenzieri
authors.forename: M A
authors.initials: MA
authors.lastname: Gertz
authors.forename: S K
authors.initials: SK
authors.lastname: Kumar
authors.forename: M Q
authors.initials: MQ
authors.lastname: Lacy
authors.forename: R A
authors.initials: RA
authors.lastname: Kyle
authors.forename: A K
authors.initials: AK
authors.lastname: Saenger
authors.forename: M
authors.initials: M
authors.lastname: Grogan
authors.forename: S R
authors.initials: SR
authors.lastname: Zeldenrust
authors.forename: S R
authors.initials: SR
authors.lastname: Hayman
authors.forename: F
authors.initials: F
authors.lastname: Buadi
authors.forename: P R
authors.initials: PR
authors.lastname: Greipp
authors.forename: N
authors.initials: N
authors.lastname: Leung
authors.forename: S R
authors.initials: SR
authors.lastname: Russell
authors.forename: D
authors.initials: D
authors.lastname: Dingli
authors.forename: J A
authors.initials: JA
authors.lastname: Lust
authors.forename: S V
authors.initials: SV
authors.lastname: Rajkumar
authors.forename: A S
authors.initials: AS
authors.lastname: Jaffe
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000686:Amyloidosis / Q000097:blood* / Q000175:diagnosis / Q000401:mortality; D009202:Cardiomyopathies / Q000097:blood* / Q000175:diagnosis / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007147:Immunoglobulin Light Chains / Q000097:blood*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012720:Severity of Illness Index; D015996:Survival Rate / Q000639:trends; D020107:Troponin T / Q000097:blood*; D014481:United States / Q000453:epidemiology
chemical_list: D007147:Immunoglobulin Light Chains; D020107:Troponin T