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Canadian Journal of Cardiology

Prognostic Value of Serial High-Sensitivity Troponin T Measurements in Adults With Congenital Heart Disease

Published:December 09, 2019DOI:https://doi.org/10.1016/j.cjca.2019.12.004

      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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