Abstract
Background
Single high-sensitivity troponin T (hs-TnT) measurement is predictive of cardiac events
in adults with congenital heart disease (ACHD). We aimed to study the prognostic value
of serial hs-TnT measurements in stable patients with ACHD.
Methods
In total, 602 consecutive patients with ACHD were enrolled in this prospective study
(2011-2013). Blood sampling was performed at enrollment and thereafter yearly during
scheduled visits, up to 4 years. Hs-TnT, N-terminal pro B-type natriuretic peptide
(NT-proBNP), and estimated glomerular filtration rate (eGFR) were measured. The composite
primary endpoint was defined as all-cause mortality, heart failure, arrhythmia, hospitalization,
cardiac (re)interventions, or thromboembolic events. The relationship between changes
in serial hs-TnT and the primary endpoint was studied by joint models with adjustment
for repeated NT-proBNP and eGFR.
Results
In 601 patients (median age, 33 [interquartile range, 25-41] years, 42% women, 90%
NYHA I), at least 1 hs-TnT measurement was performed; a mean of 4.3 hs-TnT measurements
per patient were collected. After a median follow-up of 5.8 [interquartile range,
5.3-6.3] years, 229 (38.1%) patients reached the primary endpoint. On average, hs-TnT
levels increased over time, and more in patients who reached the primary endpoint
(P < 0.001). A 2-fold higher hs-TnT was associated with the primary endpoint (unadjusted
hazard ratio, 1.62; 95% confidence interval, 1.44-1.82; P < 0.001). The association remained after adjustment for repeated eGFR but not when
adjusted for repeated NT-proBNP; repeated NT-proBNP remained associated with the primary
endpoint.
Conclusion
In stable patients with ACHD, hs-TnT levels increased before the occurrence of an
event and repeated hs-TnT was associated with the risk of adverse cardiac events.
However, repeated hs-TnT was not superior to repeated NT-proBNP.
Résumé
Contexte
Le dosage unique de la troponine T hypersensible (hs-TnT) est prédictif d’événements
cardiaques chez les adultes atteints de cardiopathie congénitale. Notre objectif était
d’étudier la valeur pronostique du dosage sériel de la hs-TnT chez des patients adultes
atteints de cardiopathie congénitale qui présentaient un état stable.
Méthodologie
Au total, 602 patients adultes atteints de cardiopathie congénitale ont été inscrits
consécutivement à cette étude prospective (2011-2013). Les prélèvements sanguins ont
été effectués au moment de l’inscription et chaque année par la suite au cours des
visites prévues, jusqu’à la quatrième année. La hs-TnT, le propeptide natriurétique
de type B N-terminal (NT-proBNP) et le taux de filtration glomérulaire estimé (TFGe)
ont été mesurés. Le paramètre d’évaluation principal regroupait les décès toutes causes
confondues, l’insuffisance cardiaque, l’arythmie cardiaque, les hospitalisations,
les (ré)interventions cardiaques et les événements thromboemboliques. La relation
entre les variations des taux sériels de hs-TnT et le paramètre d’évaluation principal
a été étudiée à l’aide de modèles conjoints corrigés pour tenir compte de la mesure
répétée du taux de NT-proBNP et du TFGe.
Résultats
Chez 601 patients (âge médian : 33 ans [intervalle interquartile : 25-41 ans], 42
% de sexe féminin, 90 % présentant une maladie de classe I de la NYHA), au moins un
dosage de la hs-TnT a été effectué; les investigateurs ont effectué, en moyenne, 4,3
dosages de la hs-TnT par patient. Au terme d’un suivi médian de 5,8 ans [intervalle
interquartile : 5,3-6,3 ans], le paramètre d’évaluation principal a été atteint chez
229 (38,1 %) patients. En moyenne, les taux de hs-TnT ont augmenté au fil du temps,
et davantage dans le cas des patients chez qui le paramètre d’évaluation principal
a été atteint (p < 0,001). Un taux de hs-TnT deux fois plus élevé était associé au paramètre d’évaluation
principal (rapport des risques instantanés non corrigé : 1,62; intervalle de confiance
à 95 % : de 1,44 à 1,82; p < 0,001). L’association a persisté après la correction visant à tenir compte de la
mesure répétée du TFGe, mais pas après la correction visant à tenir compte du dosage
répété de la NT-proBNP; le dosage répété de la NT-proBNP est demeuré associé au paramètre
d’évaluation principal.
Conclusion
Chez des patients adultes atteints de cardiopathie congénitale qui présentaient un
état stable, les taux de hs-TnT ont augmenté avant la survenue d’un événement, et
le dosage répété de la hs-TnT a été associé au risque d’événements cardiaques indésirables.
Toutefois, le dosage répété de la hs-TnT ne s’est pas avéré supérieur au dosage répété
de la NT-proBNP.
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Article info
Publication history
Published online: December 09, 2019
Accepted:
December 4,
2019
Received:
September 19,
2019
Footnotes
See editorial by Nikhanj et al., pages 1338—1340 of this issue.
See page 1523 for disclosure information.
Identification
Copyright
© 2019 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
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- Use of Serial High-Sensitive Troponin T in Patients With Adult Congenital Heart Disease: Enhancing the Detection of Major Adverse Cardiac EventsCanadian Journal of CardiologyVol. 36Issue 9
