title: Usefulness of Cardiac Troponins as Markers of Early Treatment Response in Cardiac Sarcoidosis.
abstract: Evaluation and treatment of cardiac sarcoidosis (CS) suffer from lack of sensitive and easily repeatable markers of disease activity. We studied measurements of high-sensitivity cardiac troponin T or troponin I (hs-cTnT/I) taken at presentation and during treatment in 62 patients with new-onset CS (48 women, mean age 49 years). Hs-cTnT was measured in 50 patients and was elevated (>13 ng/L) at presentation in 26 of them (52%). Hs-cTnI was measured in the remaining 12 patients and was elevated (>0.04 ng/mL) in 7 of them (58%). Left ventricular ejection fraction averaged 43 ± 14% in association with elevated hs-cTnT/I (n = 33) versus 53 ± 10% with normal hs-cTnT/I (n = 29; p = 0.001). Hs-cTnT/I was remeasured after 4 weeks of steroid therapy in 38 patients and was normalized in 16 of the 24 (67%) with an elevated pretreatment concentration and remained normal in the rest of the 14 patients (p <0.001). During follow-up (median, 17 months), cardiac death (n = 2), aborted sudden death (n = 5), sustained ventricular tachycardia (n = 8), or new complete atrioventricular block (n = 1) was recorded in 11 of 33 patients with elevated hs-cTnT/I versus in 5 of 29 with normal hs-cTnT/I (log-rank p = 0.068). Two-year event-free Kaplan-Meier cardiac survival estimate (95% confidence interval) was 67% (48% to 81%) with elevated hs-cTnT/I versus 93% (76% to 99%) with normal hs-cTnT/I. In CS, circulating hs-cTnT/I may help clinicians evaluate disease activity and treatment response. Their prognostic value remains tentative pending more follow-up data.
authors.affiliation: Division of Cardiology, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland. Electronic address: riina.kandolin@hus.fi.
authors.forename: Riina
authors.initials: R
authors.lastname: Kandolin
authors.affiliation: Division of Cardiology, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland.
authors.forename: Jukka
authors.initials: J
authors.lastname: Lehtonen
authors.affiliation: Heart Center, Turku University Hospital, Turku, Finland.
authors.forename: Juhani
authors.initials: J
authors.lastname: Airaksinen
authors.affiliation: Heart Center, Turku University Hospital, Turku, Finland.
authors.forename: Tapani
authors.initials: T
authors.lastname: Vihinen
authors.affiliation: Heart Center, Kuopio University Hospital, Kuopio, Finland.
authors.forename: Heikki
authors.initials: H
authors.lastname: Miettinen
authors.affiliation: Medical Research Center Oulu, University and University Hospital of Oulu, Oulu, Finland.
authors.forename: Kari
authors.initials: K
authors.lastname: Kaikkonen
authors.affiliation: Heart Hospital, Tampere University Hospital, Tampere, Finland.
authors.forename: Petri
authors.initials: P
authors.lastname: Haataja
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Päijät-Häme Central Hospital, Lahti, Finland.
authors.forename: Tuomas
authors.initials: T
authors.lastname: Kerola
authors.affiliation: Division of Cardiology, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland.
authors.forename: Markku
authors.initials: M
authors.lastname: Kupari
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D009202:Cardiomyopathies / Q000097:blood / Q000188:drug therapy*; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011241:Prednisone / Q000627:therapeutic use*; D011379:Prognosis; D012507:Sarcoidosis / Q000097:blood / Q000188:drug therapy*; D016896:Treatment Outcome; D019210:Troponin I / Q000097:blood*; D020107:Troponin T / Q000097:blood*
chemical_list: D015415:Biomarkers; D005938:Glucocorticoids; D019210:Troponin I; D020107:Troponin T; D011241:Prednisone