title: High sensitivity troponin T in adult congenital heart disease.
abstract: BACKGROUND
  High sensitivity troponin T (hsTnT) assays enable us to detect chronic heart failure (CHF). Adult congenital heart disease (ACHD) patients are classified as being in at least stage B of CHF. The purpose of the study was to assess hsTnT levels in ACHD patients and determine its clinical significance.
  
  
  METHODS
  This is a prospective cross-sectional study. We assessed hsTnT in 131 ACHD patients and in 30 healthy controls. All ACHD patients underwent routine clinical and echocardiographic evaluation and had hsTnT and N-terminal brain natriuretic peptide (NT-pro-BNP) level measurements.
  
  
  RESULTS
  The cut-off value defining an abnormal hsTnT level was established as >0.005 ng/mL. 35.1% (n=46) of ACHD patients had abnormal hsTnT compared to 6.7% (n=2) of healthy controls (p=0.002). The prevalence of elevated hsTnT did not differ between simple and complex and between non-cyanotic and cyanotic congenital heart disease (CHD). The sensitivity and specificity of hsTnT for the detection of moderate or severe (significant) systemic ventricular dysfunction was 78.6% and 69.8%, respectively (OR 8.49; CI 95% 2.23-32.30; p<0,0001) whereas for significant pulmonary ventricular dysfunction it was 66.7% and 68.2%, respectively (OR 4.29; CI 95% 1.56-11.79; p=0.003). In multivariate logistic regression models elevated hsTnT, but not NT-pro-BNP, was independently associated with both significant systemic ventricular dysfunction (p=0.004) and significant pulmonary ventricular dysfunction (p=0.011).
  
  
  CONCLUSIONS
  A troponin leak is observed in a substantial number of ACHD patients and is associated with significant systemic and pulmonary ventricular impairment. Compared to NT-pro-BNP, hsTnT is a more specific independent predictor of ventricular dysfunction in ACHD.
authors.affiliation: Adult Congenital Heart Disease Department, Institute of Cardiology, Warsaw, Poland. Electronic address: jrybicka@ikard.pl.
authors.forename: Justyna
authors.initials: J
authors.lastname: Rybicka
authors.affiliation: Adult Congenital Heart Disease Department, Institute of Cardiology, Warsaw, Poland.
authors.forename: Piotr
authors.initials: P
authors.lastname: Dobrowolski
authors.affiliation: Adult Congenital Heart Disease Department, Institute of Cardiology, Warsaw, Poland.
authors.forename: Magdalena
authors.initials: M
authors.lastname: Lipczyńska
authors.affiliation: Adult Congenital Heart Disease Department, Institute of Cardiology, Warsaw, Poland.
authors.forename: Ewa
authors.initials: E
authors.lastname: Kowalik
authors.affiliation: Adult Congenital Heart Disease Department, Institute of Cardiology, Warsaw, Poland.
authors.forename: Anna
authors.initials: A
authors.lastname: Klisiewicz
authors.affiliation: Adult Congenital Heart Disease Department, Institute of Cardiology, Warsaw, Poland.
authors.forename: Piotr
authors.initials: P
authors.lastname: Hoffman
authors.affiliation: Acquired Valve Disease Department, Institute of Cardiology, Warsaw, Poland.
authors.forename: Piotr
authors.initials: P
authors.lastname: Szymański
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D003430:Cross-Sectional Studies; D005260:Female; D006330:Heart Defects, Congenital / Q000097:blood* / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D020107:Troponin T / Q000097:blood*; D014463:Ultrasonography; D018754:Ventricular Dysfunction / Q000097:blood; D055815:Young Adult
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; D020107:Troponin T; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain
keywords: ACHD; Adult congenital heart disease; High sensitivity troponin T; Ventricular dysfunction