Plasma Levels of High Sensitivity Cardiac Troponin T in Adults with Repaired Tetralogy of Fallot.

Clare T M Lai,Wai-Keung Wong,Wendy W M Lam,Yiu-Fai Cheung,Kwong-Cheong Tsang,Sophia J Wong,Janice J K Ip

doi:10.1038/srep14050

Clare T M Lai, Wai-Keung Wong + Show 5 more

Open Access

https://doi.org/10.1038/srep14050

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Journal: Scientific reports	Publication Date: Sep 11, 2015
Citations: 5	License type: CC BY 4.0

Affiliation: Queen Mary Hospital, University of Hong Kong

Abstract

Detectable low circulating level of cardiac troponin T (cTnT) may reflect subclinical myocardial injury. We tested the hypothesis that circulating levels of hs-cTnT are altered in adults with repaired tetralogy of Fallot (TOF) and associated with ventricular volume load and function. Eighty-eight TOF patients and 48 controls were studied. Plasma hs-cTnT levels were determined using a highly sensitive assay (hs-cTnT). The right (RV) and left ventricular (LV) volumes and ejection fraction (EF) were measured using 3D echocardiography and, in 52 patients, cardiac magnetic resonance (CMR). The median (interquartile range) for male and female patients were 4.87 (3.83–6.62) ng/L and 3.11 (1.00–3.87) ng/L, respectively. Thirty percent of female but none of the male patients had increased hs-cTnT levels. Female patients with elevated hs-cTnT levels, compared to those without, had greater RV end-diastolic and end-systolic volumes and LV systolic dyssynchrony index (all p < 0.05). For patient cohort only, hs-cTnT levels correlated positively with CMR-derived RV end-diastolic volume and negatively with echocardiography-derived LV and RV EF (all p < 0.05). Multiple linear regression identified sex and RV EF as significant correlates of log-transformed hs-cTnT levels. Increased hs-cTnT levels occur in 30% of female patients after TOF repair, and are associated with greater RV volumes and worse RV EF.

Highlights

Dysfunction of the right and left ventricles remains to be an issue of concern in adults with repaired tetralogy of Fallot (TOF)[1,2,3]
The present study demonstrates increased plasma level of hs-cardiac troponin T (cTnT) and its association with greater right ventricular (RV) volume load, lower RV ejection fraction, and greater left ventricular (LV) mechanical dyssynchrony in adult female patients with repaired TOF
Even after adjustment of sex gender by multivariate analysis, hs-cTnT level remains to be an independent correlate of RV ejection fraction

Summary

Introduction

Dysfunction of the right and left ventricles remains to be an issue of concern in adults with repaired tetralogy of Fallot (TOF)[1,2,3]. In these patients, several factors may contribute to myocardial damage and cause progressive ventricular remodeling and dysfunction. Several factors may contribute to myocardial damage and cause progressive ventricular remodeling and dysfunction These include altered expression of genes associated with apoptosis, remodeling, and myocardial contractility[4], failure of hypoxic adaptation of the right ventricle[5], chronic pulmonary regurgitation[1,6], increased right ventricular (RV) afterload due to pulmonary arterial stenosis, ventricular fibrosis[7], and adverse ventricular-ventricular interaction[2,8,9]. Levels of hs-cTnT are altered in adults with repaired TOF and associated with ventricular volume load and function

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Results

Conclusion