Abstract
Clinical manifestations of hypertrophic cardiomyopathy (HCM) range from asymptomatic disease to early-onset heart failure and sudden cardiac death (SCD). Risk stratification for SCD remains imperfect and novel risk markers are needed. The aim of our study was to evaluate the association of elevated high-sensitivity cardiac troponin T levels (hs-cTnT) with the severity of disease expression and adverse events in patients with HCM. All patients followed-up at a dedicated HCM clinic at a tertiary care centre between April 2012 and March 2014 were analysed. The clinical care track for these patients includes 12-lead ECG, blood work-up, echocardiography, Holter ECG, exercise stress testing and cardiovascular magnetic resonance imaging (CMR). Clinical data were obtained from medical records. Of 91 HCM patients (77% males, mean age at follow up 51 ± 16 years), 46 (51%) had elevated hs-cTnT levels (>0.014 ng/ml). Patients with elevated hs-cTnT levels had greater maximum wall thickness (23 ± 7 mm vs 19 ± 3 mm, p = 0.001), more often had myocardial fibrosis (96% vs 54%, p <0.001), and lower exercise capacity (90% predicted vs 76% predicted, p = 0.002). There was a trend towards lower event-free survival estimates (Kaplan-Meier method, 15% vs 7%, p = 0.16). Elevated hs-cTnT levels in HCM patients are associated with disease severity and, potentially, with more adverse cardiac events. Future studies should test whether integration of hs-cTnT in clinical decision algorithms will improve risk stratification.
Highlights
Hypertrophic cardiomyopathy (HCM) is the most common genetic cardiovascular disorder, affecting approximately one in 500 people within the general population [1]
The aim of our study was to evaluate the association of elevated high-sensitivity cardiac troponin T levels with the severity of disease expression and adverse events in patients with hypertrophic cardiomyopathy (HCM)
All patients followed-up at a dedicated HCM clinic at a tertiary care centre between April 2012 and March 2014 were analysed
Summary
Hypertrophic cardiomyopathy (HCM) is the most common genetic cardiovascular disorder, affecting approximately one in 500 people within the general population [1]. It is defined as left ventricular hypertrophy in the absence of another cardiac or systemic disease (e.g. arterial hypertension, aortic stenosis, metabolic cardiomyopathy) capable of producing the magnitude of hypertrophy evident [2]. Several studies suggest that elevated biomarkers including cardiac troponins may be associated with more severe disease expression and potentially adverse outcome in patients with HCM, similar to patients with heart failure from other causes [10,11,12,13]. The aim of our study was to assess the prevalence of elevated high-sensitivity cardiac troponin T (hs-cTnT) levels in HCM patients followed-up at our tertiary referral centre in Switzerland, and to assess the association of hscTnT with disease severity and adverse cardiovascular outcome
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