Association of cardiac troponin i with disease severity and outcomes in patients with pulmonary hypertension

Mariella Vélez-Martínez, Colby Ayers, Joseph D. Mishkin, Sonja D Bartolome, Christine K Garcia, Fernando Torres, Mark H Drazner, James A de Lemos, Aslan T Turer, Kelly M Chin

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Previous studies have identified cardiac troponin I (cTnI) as an important marker in pulmonary hypertension (PH) prognosis. However, traditional assays are limited by poor sensitivity, even among patients at high risk. cTnI was measured in 255 PH patients using a new highly sensitive (hs) assay. Other measures included demographics, creatinine, 6-minute walk distance, hemodynamics, cardiac magnetic resonance imaging, and B-type natriuretic peptide level. The association between cTnI and survival was assessed using Kaplan-Meier analysis and Cox regression. cTnI was detectable with the hs assay in 95% of the patients with a median level of 6.9 pg/ml (IQR 2.7-12.6 pg/ml). Higher cTnI levels associated with higher levels of B-type natriuretic peptide, shorter 6-minute walk distance, and more severe hemodynamic and cardiac magnetic resonance imaging abnormalities. During a median follow-up of 3.5 years, 60 individuals died. Unadjusted event rates increased across higher cTnI quartiles (3, 5, 13, 17 events/100 person-years, respectively, p trend = 0.002). cTnI in the fourth (vs first) quartile remained associated with death in a final stepwise multivariable model that included clinical variables and hemodynamics (adjusted hazard ratio 5.3, 95% confidence interval 1.8-15.6). In conclusion, cTnI levels, detectable with a novel hs assay, identify patients with PH who have more severe hemodynamic and cardiac structural abnormalities and provide novel and independent prognostic information. This hs assay has the potential to detect more at-risk patients and improve current risk-stratification algorithms.

Original languageEnglish (US)
Pages (from-to)1812-1817
Number of pages6
JournalAmerican Journal of Cardiology
Volume111
Issue number12
DOIs
StatePublished - Jun 15 2013

Fingerprint

Troponin
Troponin I
Pulmonary Hypertension
Hemodynamics
Brain Natriuretic Peptide
Magnetic Resonance Imaging
Kaplan-Meier Estimate
Creatinine
Demography
Confidence Intervals
Survival

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Association of cardiac troponin i with disease severity and outcomes in patients with pulmonary hypertension. / Vélez-Martínez, Mariella; Ayers, Colby; Mishkin, Joseph D.; Bartolome, Sonja D; Garcia, Christine K; Torres, Fernando; Drazner, Mark H; de Lemos, James A; Turer, Aslan T; Chin, Kelly M.

In: American Journal of Cardiology, Vol. 111, No. 12, 15.06.2013, p. 1812-1817.

Research output: Contribution to journalArticle

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abstract = "Previous studies have identified cardiac troponin I (cTnI) as an important marker in pulmonary hypertension (PH) prognosis. However, traditional assays are limited by poor sensitivity, even among patients at high risk. cTnI was measured in 255 PH patients using a new highly sensitive (hs) assay. Other measures included demographics, creatinine, 6-minute walk distance, hemodynamics, cardiac magnetic resonance imaging, and B-type natriuretic peptide level. The association between cTnI and survival was assessed using Kaplan-Meier analysis and Cox regression. cTnI was detectable with the hs assay in 95{\%} of the patients with a median level of 6.9 pg/ml (IQR 2.7-12.6 pg/ml). Higher cTnI levels associated with higher levels of B-type natriuretic peptide, shorter 6-minute walk distance, and more severe hemodynamic and cardiac magnetic resonance imaging abnormalities. During a median follow-up of 3.5 years, 60 individuals died. Unadjusted event rates increased across higher cTnI quartiles (3, 5, 13, 17 events/100 person-years, respectively, p trend = 0.002). cTnI in the fourth (vs first) quartile remained associated with death in a final stepwise multivariable model that included clinical variables and hemodynamics (adjusted hazard ratio 5.3, 95{\%} confidence interval 1.8-15.6). In conclusion, cTnI levels, detectable with a novel hs assay, identify patients with PH who have more severe hemodynamic and cardiac structural abnormalities and provide novel and independent prognostic information. This hs assay has the potential to detect more at-risk patients and improve current risk-stratification algorithms.",
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