High-sensitive troponin-T in adult congenital heart disease.
BACKGROUND
Adult congenital heart disease (ACHD) patients are at risk of late complications including arrhythmias, heart failure and sudden death. High-sensitive troponin-T (hs-TnT) is the standard for diagnosing acute coronary syndrome, but is also associated with cardiac function and prognosis in other cardiac diseases. We aimed to describe hs-TnT level in ACHD patients, and determine its relationship with cardiac function and other biomarkers.


METHODS
Consecutive ACHD patients, visiting the outpatient clinic, underwent echocardiography, exercise testing and venipuncture on the same day.


RESULTS
In total 587 patients were included (median age 33 [IQR 25-41] years, 58% male, 90% NYHA class I). hs-TnT was above the detection limit of 5 ng/L in 241 patients (41%), of whom 47 (8%) had hs-TnT levels above the 99th percentile of normal of 14 ng/L. hs-TnT levels were highest in patients with a systemic RV or pulmonary hypertension. Patients with normal or non-detectable hs-TnT were younger (32 [IQR 24-40] years) than patient with elevated hs-TnT (42 [IQR 36-60] years, p<0.001). The prevalence of hs-TnT ≥14 ng/L was higher in patients with NYHA ≥II (36%, p<0.001), systemic systolic dysfunction (38%, p<0.001), non-sinus rhythm (43%, p<0.001) and elevated pulmonary pressures (39%, p<0.001). hs-TnT was correlated with NT-proBNP (r=0.400, p<0.001).


CONCLUSIONS
hs-TnT above the 99th percentile of normal is observed in a non-trivial portion of stable ACHD patients, especially in those with a systemic RV or elevated pulmonary pressures. Since this biomarker of myocardial damage is related to NT-proBNP and ventricular function, its potential predictive value in ACHD patients seems promising and further investigation of underlying mechanisms is warranted.
Department of cardiology, Thorax Center, Erasmus MC, Rotterdam, The Netherlands.
Jannet A
JA
Eindhoven
Department of cardiology, Thorax Center, Erasmus MC, Rotterdam, The Netherlands. Electronic address: j.roos@erasmusmc.nl.
Jolien W
JW
Roos-Hesselink
Department of cardiology, Thorax Center, Erasmus MC, Rotterdam, The Netherlands.
Annemien E
AE
van den Bosch
Department of cardiology, Thorax Center, Erasmus MC, Rotterdam, The Netherlands.
Isabella
I
Kardys
Department of cardiology, Thorax Center, Erasmus MC, Rotterdam, The Netherlands.
Jin M
JM
Cheng
Department of cardiology, Thorax Center, Erasmus MC, Rotterdam, The Netherlands.
Jesse F
JF
Veenis
Department of cardiology, Thorax Center, Erasmus MC, Rotterdam, The Netherlands.
Judith A A E
JAAE
Cuypers
Department of cardiology, Thorax Center, Erasmus MC, Rotterdam, The Netherlands.
Maarten
M
Witsenburg
Department of Clinical Chemistry, Erasmus MC, Rotterdam, The Netherlands.
Ron H N
RHN
van Schaik
Department of cardiology, Thorax Center, Erasmus MC, Rotterdam, The Netherlands.
Eric
E
Boersma
D000328:Adult; D001145:Arrhythmias, Cardiac / Q000175:diagnosis* / Q000209:etiology; D015415:Biomarkers / Q000097:blood; D016757:Death, Sudden, Cardiac / Q000209:etiology / Q000517:prevention & control*; D004452:Echocardiography / Q000379:methods; D004562:Electrocardiography; D005080:Exercise Test; D005260:Female; D006330:Heart Defects, Congenital / Q000097:blood / Q000175:diagnosis / Q000503:physiopathology; D006333:Heart Failure / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011237:Predictive Value of Tests; D011379:Prognosis; D020107:Troponin T / Q000097:blood*; D016276:Ventricular Function
D015415:Biomarkers; D010446:Peptide Fragments; D020107:Troponin T; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain
Adult congenital heart disease; Echocardiography; Exercise testing; High-sensitive troponin T