Association of troponin T, detected with highly sensitive assay, and outcomes in infective endocarditis

Amy B. Stancoven, Angela B. Shiue, Amit Khera, Kristi Pinkston, Ibrahim A Hashim, Andrew Wang, James A de Lemos, Gail E Peterson

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Troponin levels have been correlated with adverse outcomes in multiple disease processes, including congestive heart failure, acute coronary syndromes, sepsis, and, in a few small series, infective endocarditis. We hypothesized that a novel measurement of troponin using a highly sensitive assay would correlate with adverse outcomes when prospectively studied in patients with infective endocarditis. At a single center in the International Collaboration on Endocarditis, 42 patients met the inclusion criteria and underwent testing for cardiac troponin T (cTnT) using both a standard and a highly sensitive precommercial assay. The cTnT levels were associated with the prespecified primary composite outcome of death, central nervous system event, and cardiac abscess. Secondary outcomes included the individual components of the composite outcome and the need for cardiac surgery. A receiver operating characteristic curve was derived and used to identify the optimal cutpoint for cTnT using the highly sensitive assay. cTnT was detectable with the highly sensitive assay in 39 (93%) of 42 patients with infective endocarditis and with the standard assay in 25 (56%) of 42 (p <0.05). Of the 42 patients, 15 experienced the composite outcome, 4 died, 9 had a central nervous system event, and 5 had a cardiac abscess. With the hs-cTnT assay, the median cTnT was greater in the patients who experienced the primary outcome (0.12 vs 0.02 ng/ml, p <0.05). According to the receiver operating characteristic curve analysis (area under the curve of 0.74), cTnT levels of <0.08 ng/ml produced optimal specificity (78%) for the primary outcome. The patients with a cTnT level of <0.08 ng/ml were more likely to experience the primary outcome (odds ratio 7.0, 95% confidence interval 1.7 to 28.6, p <0.01) and a central nervous system event (odds ratio 9.3, 95% confidence interval 1.3 to 24.1, p = 0.02). In conclusion, cTnT is detectable in 93% of patients with infective endocarditis using a novel highly sensitive assay, with higher levels correlating with poor clinical outcomes.

Original languageEnglish (US)
Pages (from-to)416-420
Number of pages5
JournalAmerican Journal of Cardiology
Volume108
Issue number3
DOIs
StatePublished - Aug 1 2011

Fingerprint

Troponin T
Endocarditis
Troponin
Central Nervous System
ROC Curve
Abscess
Odds Ratio
Confidence Intervals
Acute Coronary Syndrome
Thoracic Surgery
Area Under Curve
Sepsis
Heart Failure

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Association of troponin T, detected with highly sensitive assay, and outcomes in infective endocarditis. / Stancoven, Amy B.; Shiue, Angela B.; Khera, Amit; Pinkston, Kristi; Hashim, Ibrahim A; Wang, Andrew; de Lemos, James A; Peterson, Gail E.

In: American Journal of Cardiology, Vol. 108, No. 3, 01.08.2011, p. 416-420.

Research output: Contribution to journalArticle

@article{75d2091343fb4c8cbfac73905a9e4467,
title = "Association of troponin T, detected with highly sensitive assay, and outcomes in infective endocarditis",
abstract = "Troponin levels have been correlated with adverse outcomes in multiple disease processes, including congestive heart failure, acute coronary syndromes, sepsis, and, in a few small series, infective endocarditis. We hypothesized that a novel measurement of troponin using a highly sensitive assay would correlate with adverse outcomes when prospectively studied in patients with infective endocarditis. At a single center in the International Collaboration on Endocarditis, 42 patients met the inclusion criteria and underwent testing for cardiac troponin T (cTnT) using both a standard and a highly sensitive precommercial assay. The cTnT levels were associated with the prespecified primary composite outcome of death, central nervous system event, and cardiac abscess. Secondary outcomes included the individual components of the composite outcome and the need for cardiac surgery. A receiver operating characteristic curve was derived and used to identify the optimal cutpoint for cTnT using the highly sensitive assay. cTnT was detectable with the highly sensitive assay in 39 (93{\%}) of 42 patients with infective endocarditis and with the standard assay in 25 (56{\%}) of 42 (p <0.05). Of the 42 patients, 15 experienced the composite outcome, 4 died, 9 had a central nervous system event, and 5 had a cardiac abscess. With the hs-cTnT assay, the median cTnT was greater in the patients who experienced the primary outcome (0.12 vs 0.02 ng/ml, p <0.05). According to the receiver operating characteristic curve analysis (area under the curve of 0.74), cTnT levels of <0.08 ng/ml produced optimal specificity (78{\%}) for the primary outcome. The patients with a cTnT level of <0.08 ng/ml were more likely to experience the primary outcome (odds ratio 7.0, 95{\%} confidence interval 1.7 to 28.6, p <0.01) and a central nervous system event (odds ratio 9.3, 95{\%} confidence interval 1.3 to 24.1, p = 0.02). In conclusion, cTnT is detectable in 93{\%} of patients with infective endocarditis using a novel highly sensitive assay, with higher levels correlating with poor clinical outcomes.",
author = "Stancoven, {Amy B.} and Shiue, {Angela B.} and Amit Khera and Kristi Pinkston and Hashim, {Ibrahim A} and Andrew Wang and {de Lemos}, {James A} and Peterson, {Gail E}",
year = "2011",
month = "8",
day = "1",
doi = "10.1016/j.amjcard.2011.03.061",
language = "English (US)",
volume = "108",
pages = "416--420",
journal = "American Journal of Cardiology",
issn = "0002-9149",
publisher = "Elsevier Inc.",
number = "3",

}

TY - JOUR

T1 - Association of troponin T, detected with highly sensitive assay, and outcomes in infective endocarditis

AU - Stancoven, Amy B.

AU - Shiue, Angela B.

AU - Khera, Amit

AU - Pinkston, Kristi

AU - Hashim, Ibrahim A

AU - Wang, Andrew

AU - de Lemos, James A

AU - Peterson, Gail E

PY - 2011/8/1

Y1 - 2011/8/1

N2 - Troponin levels have been correlated with adverse outcomes in multiple disease processes, including congestive heart failure, acute coronary syndromes, sepsis, and, in a few small series, infective endocarditis. We hypothesized that a novel measurement of troponin using a highly sensitive assay would correlate with adverse outcomes when prospectively studied in patients with infective endocarditis. At a single center in the International Collaboration on Endocarditis, 42 patients met the inclusion criteria and underwent testing for cardiac troponin T (cTnT) using both a standard and a highly sensitive precommercial assay. The cTnT levels were associated with the prespecified primary composite outcome of death, central nervous system event, and cardiac abscess. Secondary outcomes included the individual components of the composite outcome and the need for cardiac surgery. A receiver operating characteristic curve was derived and used to identify the optimal cutpoint for cTnT using the highly sensitive assay. cTnT was detectable with the highly sensitive assay in 39 (93%) of 42 patients with infective endocarditis and with the standard assay in 25 (56%) of 42 (p <0.05). Of the 42 patients, 15 experienced the composite outcome, 4 died, 9 had a central nervous system event, and 5 had a cardiac abscess. With the hs-cTnT assay, the median cTnT was greater in the patients who experienced the primary outcome (0.12 vs 0.02 ng/ml, p <0.05). According to the receiver operating characteristic curve analysis (area under the curve of 0.74), cTnT levels of <0.08 ng/ml produced optimal specificity (78%) for the primary outcome. The patients with a cTnT level of <0.08 ng/ml were more likely to experience the primary outcome (odds ratio 7.0, 95% confidence interval 1.7 to 28.6, p <0.01) and a central nervous system event (odds ratio 9.3, 95% confidence interval 1.3 to 24.1, p = 0.02). In conclusion, cTnT is detectable in 93% of patients with infective endocarditis using a novel highly sensitive assay, with higher levels correlating with poor clinical outcomes.

AB - Troponin levels have been correlated with adverse outcomes in multiple disease processes, including congestive heart failure, acute coronary syndromes, sepsis, and, in a few small series, infective endocarditis. We hypothesized that a novel measurement of troponin using a highly sensitive assay would correlate with adverse outcomes when prospectively studied in patients with infective endocarditis. At a single center in the International Collaboration on Endocarditis, 42 patients met the inclusion criteria and underwent testing for cardiac troponin T (cTnT) using both a standard and a highly sensitive precommercial assay. The cTnT levels were associated with the prespecified primary composite outcome of death, central nervous system event, and cardiac abscess. Secondary outcomes included the individual components of the composite outcome and the need for cardiac surgery. A receiver operating characteristic curve was derived and used to identify the optimal cutpoint for cTnT using the highly sensitive assay. cTnT was detectable with the highly sensitive assay in 39 (93%) of 42 patients with infective endocarditis and with the standard assay in 25 (56%) of 42 (p <0.05). Of the 42 patients, 15 experienced the composite outcome, 4 died, 9 had a central nervous system event, and 5 had a cardiac abscess. With the hs-cTnT assay, the median cTnT was greater in the patients who experienced the primary outcome (0.12 vs 0.02 ng/ml, p <0.05). According to the receiver operating characteristic curve analysis (area under the curve of 0.74), cTnT levels of <0.08 ng/ml produced optimal specificity (78%) for the primary outcome. The patients with a cTnT level of <0.08 ng/ml were more likely to experience the primary outcome (odds ratio 7.0, 95% confidence interval 1.7 to 28.6, p <0.01) and a central nervous system event (odds ratio 9.3, 95% confidence interval 1.3 to 24.1, p = 0.02). In conclusion, cTnT is detectable in 93% of patients with infective endocarditis using a novel highly sensitive assay, with higher levels correlating with poor clinical outcomes.

UR - http://www.scopus.com/inward/record.url?scp=79960356285&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=79960356285&partnerID=8YFLogxK

U2 - 10.1016/j.amjcard.2011.03.061

DO - 10.1016/j.amjcard.2011.03.061

M3 - Article

VL - 108

SP - 416

EP - 420

JO - American Journal of Cardiology

JF - American Journal of Cardiology

SN - 0002-9149

IS - 3

ER -