Abstract 18318: Clinical Value of Increased High-Sensitivity Cardiac Troponin T in Patients with Essential Hypertension

Abstract

Background: Many studies including ours have shown the existence of ongoing myocardial damage detected as increased levels of cardiac troponin T (cTnT) in patients with chronic heart failure. We previously reported elevated levels of conventional cardiac troponin T in some patients with essential hypertension (EHT), an important precursor of heart failure. However, it has remained unclear whether myocardial damage and/or injury exist and its clinical value in patients with EHT. Newly developed high sensitive cardiac troponin T (Hs-cTnT) is more sensitive for the detection of myocardial damage and/or injury. Methods: We measured Hs-cTnT in 103 consecutive patients with EHT without prior ischemic heart disease, myocarditis and heart failure, and left ventricular (LV) systolic (LVEF <55%) and renal dysfunction (estimated glomerular filtration rate [eGFR] <30ml/min/1.73m2), and 20 normal controls. Hs-cTnT levels were compared with clinical parameters including neurohumoral factors (plasma renin activity and plasma aldosterone, norepinephrine and B-type natriuretic peptide [BNP] concentrations) and echocardiographic findings (left atrial dimension [LAD], LVEF, LV end-diastolic diameter, Tei index and mass index, E/A ratio and E/e’). Results: Hs-cTnT was detectable (>0.003 ng/ml) in 61 of 103 (59%) patients, but 2 (10%) of 20 controls (p<0.0002). In patients with EHT, univariate logistic regression analyses showed that age >70 years, eGFR <60 ml/min/1.73m2, BNP >23.2 pg/ml and LAD >36mm were significantly associated with Hs-TnT detection. In multivariate logistic regression anaysis including 7 variables (age, BNP, LAD and plasma renin activity and aldosterone concentration > median value, E/A ratio < median value and eGFR <60 ml/min/1.73m2) that were associated with Hs-cTnT detection at p <0.1 in univariate analyses, BNP >23.2 pg/ml (odds ratio 4.00, p=0.01) and LAD >36mm (odds ratio 3.96, p=0.007) were independently associated with Hs-TnT detection. In 61 patients with Hs-cTnT detection, Hs-cTnT significantly correlated with BNP(r=0.28, p=0.03) alone. Conclusion: The results of the present study suggest the presence of minute myocardial injury that might be associated with myocardial stress in patients with EHT.