Abstract 13252: High-sensitivity Troponin T is a Useful Biomarker of Hemodynamics Response After Balloon Pulmonary Angioplasty in Patients With Chronic Thromboembolic Pulmonary Hypertension

Abstract

Introduction: Balloon pulmonary angioplasty (BPA) improves hemodynamics in patients with chronic thromboembolic pulmonary hypertension (CTEPH). Cardiac troponin is a marker of ongoing myocardial damage, and reflects hemodynamics in patients with left-heart failure. However, the clinical significance of cardiac troponin in CTEPH patients treated with BPA was unknown. We hypothesized that cardiac troponin is a surrogate marker of hemodynamic response in CTEPH patients who underwent BPA. Methods and Results: We analyzed 63 consecutive CTEPH patients who underwent BPA procedures, and measured high-sensitivity troponin T (hsTnT) level using electrochemiluminescence immunoassay before and after BPA from November 2012 to May 2015 (age; 62.8±14.3 years, female; n=41, number of target vessels per patient; 13.3±2.4, total sessions per patient; 5.9±1.9). Elevation of baseline hsTnT was associated with older age (p<0.05). Patients with baseline hsTnT level > median value (0.012 ng/ml) was associated with higher right atrium pressure (7.5±3.8 vs 5.9±2.2 mmHg, p<0.05), mean pulmonary artery pressure (mPAP; 41.4±11.0 vs 34.9±9.6 mmHg, p<0.05), pulmonary vascular resistance (PVR; 926.7±663.3 vs 731.1±931.8 dynes•sec•cm-5, p<0.05) and lower pulmonary capillary wedge pressure (8.2±2.9 vs 10.4±4.9 mmHg, p<0.05) and six-minute walk distance (265.9±98.9 vs 342.0±80.9 m, p<0.05), but not associated with cardiac output. BPA improved mPAP (from 38.1±10.7 to 21.1±5.6 mmHg, p<0.05) and PVR (from 823.6±828.2 to 292.8±129.6 dynes•sec•cm-5, p<0.05). HsTnT significantly decreased after BPA (from 0.015±0.012 to 0.012±0.009 ng/mL; p<0.05). Based on change of HsTnT after BPA, we divided the patients into two groups: HsTnT-decrease group (n=34) and HsTnT-increase or stable group (n=29). HsTnT-decrease group showed greater decreases in mPAP and PVR (delta mPAP 20.1±10.3 vs 13.3±11.3 mmHg, p<0.05, delta PVR 686.4±982.6 vs 352.3±452.5 dynes•sec•cm-5, p<0.05) after BPA. Conclusions: HsTnT level is a useful biomarker of hemodynamics severity, and change of hsTnT reflected improvement of hemodynamics in CTEPH patients who underwent BPA. Serial measurements of hsTnT could be a less-invasive and useful strategy to monitor therapeutic impact of BPA.