High-sensitivity troponin I concentrations are a marker of an advanced hypertrophic response and adverse outcomes in patients with aortic stenosis.
OBJECTIVE
High-sensitivity cardiac troponin I (cTnI) assays hold promise in detecting the transition from hypertrophy to heart failure in aortic stenosis. We sought to investigate the mechanism for troponin release in patients with aortic stenosis and whether plasma cTnI concentrations are associated with long-term outcome.


RESULTS
Plasma cTnI concentrations were measured in two patient cohorts using a high-sensitivity assay. First, in the Mechanism Cohort, 122 patients with aortic stenosis (median age 71, 67% male, aortic valve area 1.0 ± 0.4 cm(2)) underwent cardiovascular magnetic resonance and echocardiography to assess left ventricular (LV) myocardial mass, function, and fibrosis. The indexed LV mass and measures of replacement fibrosis (late gadolinium enhancement) were associated with cTnI concentrations independent of age, sex, coronary artery disease, aortic stenosis severity, and diastolic function. In the separate Outcome Cohort, 131 patients originally recruited into the Scottish Aortic Stenosis and Lipid Lowering Trial, Impact of REgression (SALTIRE) study, had long-term follow-up for the occurrence of aortic valve replacement (AVR) and cardiovascular deaths. Over a median follow-up of 10.6 years (1178 patient-years), 24 patients died from a cardiovascular cause and 60 patients had an AVR. Plasma cTnI concentrations were associated with AVR or cardiovascular death HR 1.77 (95% CI, 1.22 to 2.55) independent of age, sex, systolic ejection fraction, and aortic stenosis severity.


CONCLUSIONS
In patients with aortic stenosis, plasma cTnI concentration is associated with advanced hypertrophy and replacement myocardial fibrosis as well as AVR or cardiovascular death.
BHF/Centre for Cardiovascular Science, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4SB, UK National Heart Center Singapore, Singapore cchin03m@gmail.com.
Calvin W L
CW
Chin
BHF/Centre for Cardiovascular Science, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4SB, UK.
Anoop S V
AS
Shah
Centre of Population Health Sciences, University of Edinburgh, UK.
David A
DA
McAllister
BHF/Centre for Cardiovascular Science, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4SB, UK.
S
S
Joanna Cowell
BHF/Centre for Cardiovascular Science, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4SB, UK.
Shirjel
S
Alam
BHF/Centre for Cardiovascular Science, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4SB, UK.
Jeremy P
JP
Langrish
BHF/Centre for Cardiovascular Science, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4SB, UK.
Fiona E
FE
Strachan
BHF/Centre for Cardiovascular Science, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4SB, UK.
Amanda L
AL
Hunter
Division of Cardiovascular and Diabetes Medicine, Ninewells Hospital and Medical School, UK.
Anna
A
Maria Choy
Division of Cardiovascular and Diabetes Medicine, Ninewells Hospital and Medical School, UK.
Chim C
CC
Lang
Department of Clinical Biochemistry, Royal Infirmary of Edinburgh, UK.
Simon
S
Walker
BHF/Centre for Cardiovascular Science, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4SB, UK.
Nicholas A
NA
Boon
BHF/Centre for Cardiovascular Science, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4SB, UK.
David E
DE
Newby
BHF/Centre for Cardiovascular Science, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4SB, UK.
Nicholas L
NL
Mills
BHF/Centre for Cardiovascular Science, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4SB, UK.
Marc R
MR
Dweck
D000368:Aged; D001024:Aortic Valve Stenosis / Q000097:blood* / Q000401:mortality / Q000601:surgery; D001681:Biological Assay; D015415:Biomarkers / Q000378:metabolism; D003287:Contrast Media; D042241:Early Diagnosis; D005260:Female; D005355:Fibrosis / Q000175:diagnosis / Q000401:mortality; D005500:Follow-Up Studies; D006333:Heart Failure / Q000175:diagnosis* / Q000401:mortality; D019918:Heart Valve Prosthesis Implantation / Q000401:mortality; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000175:diagnosis* / Q000401:mortality; D053208:Kaplan-Meier Estimate; D018810:Magnetic Resonance Angiography / Q000379:methods; D008297:Male; D009206:Myocardium / Q000473:pathology*; D020097:Natriuretic Peptide, Brain / Q000378:metabolism; D009942:Organometallic Compounds; D011379:Prognosis; D013318:Stroke Volume / Q000502:physiology; D014057:Tomography, X-Ray Computed; D019210:Troponin I / Q000378:metabolism*
D015415:Biomarkers; D003287:Contrast Media; D009942:Organometallic Compounds; D019210:Troponin I; D020097:Natriuretic Peptide, Brain; C090600:gadobutrol
Aortic stenosis; Cardiac magnetic resonance; High-sensitivity troponin; Left ventricular hypertrophy; Myocardial fibrosis