Combined evaluation ofcoronary artery disease and high-sensitivity cardiac troponin T forprediction of adverse events inpatients with hypertrophic cardiomyopathy

Hang Liao,Xiaoping Chen,Huay Cheem Tan,Sen He,Yong He,Ziqiong Wang

doi:10.1186/s12872-021-02135-x

Abstract

BackgroundThis study was performed to investigate the clinical significance of combined evaluation of both coronary artery disease (CAD) and high-sensitivity cardiac troponin T (hs-cTnT) for prediction of major adverse cardiovascular events (MACEs) in patients with hypertrophic cardiomyopathy (HCM).MethodsWe performed clinical evaluations, including coronary artery imaging and hs-cTnT measurement, in 162 patients with HCM.ResultsThe patients were followed up for a median period of 3.7 years (interquartile range 2.4–5.6 years; total of 632.3 person-years [PYs]), during which time MACEs occurred in 24 (14.8%) patients. The incidence of MACEs was 6.4 and 2.7 per 100 PYs for patients with CAD and normal coronary arteries, respectively; similarly, the incidence was 5.8 and 2.1 per 100 PYs in patients with an elevated hs-cTnT concentration (> 14.0 ng/L) and a normal hs-cTnT concentration, respectively. The multivariate analysis suggested that CAD and an elevated hs-cTnT concentration tended to be positively associated with MACEs. When the groups were allocated according to these two markers, the patients were divided into four groups, which further improved the predictive values. The incidence of MACEs was 10.4 per 100 PYs in the CAD and elevated hs-cTnT group, which was much higher than the incidence in all other groups (range, 2.0–3.5 per 100 PYs). With the normal coronary arteries and normal hs-cTnT group serving as a reference, the adjusted hazard ratio was 5.0 (95% confidence interval 1.0–23.8; P = 0.046) for the CAD and elevated hs-cTnT group. In addition, the subgroup analysis showed similar findings among the patients without severe CAD.ConclusionsIn patients with HCM, combined evaluation of both CAD and hs-cTnT might facilitate more reliable prediction of MACEs than evaluation of a single marker. These may serve as clinically useful markers to guide risk management.

Highlights

This study was performed to investigate the clinical significance of combined evaluation of both coronary artery disease (CAD) and high-sensitivity cardiac troponin T for prediction of major adverse cardiovascular events (MACEs) in patients with hypertrophic cardiomyopathy (HCM)
Baseline characteristics Compared with the patients in the normal coronary arteries (NCA) group, the patients in the CAD group were older and had higher incidences of hypertension, diabetes, current or prior tobacco use, vascular diseases, and LV outflow tract (LVOT) obstruction
The results showed that the CAD and elevated high-sensitivity cardiac troponin T (hs-cTnT) group still tended to be positively associated with new-onset MACEs

Summary

Introduction

This study was performed to investigate the clinical significance of combined evaluation of both coronary artery disease (CAD) and high-sensitivity cardiac troponin T (hs-cTnT) for prediction of major adverse cardiovascular events (MACEs) in patients with hypertrophic cardiomyopathy (HCM). CAD can cause a decrease in coronary blood flow to different degrees, and in patients who have HCM without myocardial infarction, an elevated hs-cTnT concentration may indicate microvascular dysfunction [10, 12]. These parameters might represent the total ischemic burden of the myocardium in HCM, which is considered to be associated with poor outcomes.

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Discussion

Conclusion