title: Elevated high-sensitivity troponin T levels are associated with adverse cardiac remodelling and myocardial fibrosis in hypertrophic cardiomyopathy.
abstract: BACKGROUND
  Clinical manifestations of hypertrophic cardiomyopathy (HCM) range from asymptomatic disease to early-onset heart failure and sudden cardiac death (SCD). Risk stratification for SCD remains imperfect and novel risk markers are needed. The aim of our study was to evaluate the association of elevated high-sensitivity cardiac troponin T levels (hs-cTnT) with the severity of disease expression and adverse events in patients with HCM.
  
  
  METHODS
  All patients followed-up at a dedicated HCM clinic at a tertiary care centre between April 2012 and March 2014 were analysed. The clinical care track for these patients includes 12-lead ECG, blood work-up, echocardiography, Holter ECG, exercise stress testing and cardiovascular magnetic resonance imaging (CMR). Clinical data were obtained from medical records.
  
  
  RESULTS
  Of 91 HCM patients (77% males, mean age at follow up 51 ± 16 years), 46 (51%) had elevated hs-cTnT levels (>0.014 ng/ml). Patients with elevated hs-cTnT levels had greater maximum wall thickness (23 ± 7 mm vs 19 ± 3 mm, p = 0.001), more often had myocardial fibrosis (96% vs 54%, p <0.001), and lower exercise capacity (90% predicted vs 76% predicted, p = 0.002). There was a trend towards lower event-free survival estimates (Kaplan-Meier method, 15% vs 7%, p = 0.16).
  
  
  CONCLUSIONS
  Elevated hs-cTnT levels in HCM patients are associated with disease severity and, potentially, with more adverse cardiac events. Future studies should test whether integration of hs-cTnT in clinical decision algorithms will improve risk stratification.
authors.affiliation: University Heart Centre, Department of Cardiology, University Hospital Zurich, Switzerland.
authors.forename: Stefanie
authors.initials: S
authors.lastname: Hasler
authors.affiliation: University Heart Centre, Department of Cardiology, University Hospital Zurich, Switzerland.
authors.forename: Robert
authors.initials: R
authors.lastname: Manka
authors.affiliation: University Heart Centre, Department of Cardiology, University Hospital Zurich, Switzerland.
authors.forename: Matthias
authors.initials: M
authors.lastname: Greutmann
authors.affiliation: University Heart Centre, Department of Cardiology, University Hospital Zurich, Switzerland.
authors.forename: Oliver
authors.initials: O
authors.lastname: Gämperli
authors.forename: Christian
authors.initials: C
authors.lastname: Schmied
authors.affiliation: University Heart Centre, Department of Cardiology, University Hospital Zurich, Switzerland.
authors.forename: Felix C
authors.initials: FC
authors.lastname: Tanner
authors.affiliation: Heart Clinic, Hirslanden, Zurich, Switzerland.
authors.forename: Patric
authors.initials: P
authors.lastname: Biaggi
authors.affiliation: University Heart Centre, Department of Cardiology, University Hospital Zurich, Switzerland.
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Lüscher
authors.affiliation: Emergency Department, University Hospital Zurich, Switzerland.
authors.forename: Dagmar I
authors.initials: DI
authors.lastname: Keller
authors.affiliation: University Heart Centre, Department of Cardiology, University Hospital Zurich, Switzerland.
authors.forename: Christiane
authors.initials: C
authors.lastname: Gruner
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D064752:Atrial Remodeling; D002312:Cardiomyopathy, Hypertrophic / Q000097:blood*; D015331:Cohort Studies; D004452:Echocardiography; D004562:Electrocardiography; D005080:Exercise Test; D005260:Female; D005355:Fibrosis / Q000097:blood; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology*; D009929:Organ Size; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D062606:Tertiary Care Centers; D020107:Troponin T / Q000097:blood*; D020257:Ventricular Remodeling; D055815:Young Adult
chemical_list: D020107:Troponin T