High-sensitivity troponin I concentrations are a marker of an advanced hypertrophic response and adverse outcomes in patients with aortic stenosis

Calvin W. L. Chin (Lead / Corresponding author), Anoop S. V. Shah, David A. McAllister, S. Joanna Cowell, Shirjel Alam, Jeremy P. Langrish, Fiona E. Strachan, Amanda L. Hunter, Anna Maria Choy, Chim C. Lang, Simon Walker, Nicholas A. Boon, David E. Newby, Nicholas L. Mills, Marc R. Dweck

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    Abstract

    Aims
    High-sensitivity cardiac troponin I (cTnI) assays hold promise in detecting the transition from hypertrophy to heart failure in aortic stenosis. We sought to investigate the mechanism for troponin release in patients with aortic stenosis and whether plasma cTnI concentrations are associated with long-term outcome.

    Methods and results
    Plasma cTnI concentrations were measured in two patient cohorts using a high-sensitivity assay. First, in the Mechanism Cohort, 122 patients with aortic stenosis (median age 71, 67% male, aortic valve area 1.0 ± 0.4 cm2) underwent cardiovascular magnetic resonance and echocardiography to assess left ventricular (LV) myocardial mass, function, and fibrosis. The indexed LV mass and measures of replacement fibrosis (late gadolinium enhancement) were associated with cTnI concentrations independent of age, sex, coronary artery disease, aortic stenosis severity, and diastolic function. In the separate Outcome Cohort, 131 patients originally recruited into the Scottish Aortic Stenosis and Lipid Lowering Trial, Impact of REgression (SALTIRE) study, had long-term follow-up for the occurrence of aortic valve replacement (AVR) and cardiovascular deaths. Over a median follow-up of 10.6 years (1178 patient-years), 24 patients died from a cardiovascular cause and 60 patients had an AVR. Plasma cTnI concentrations were associated with AVR or cardiovascular death HR 1.77 (95% CI, 1.22 to 2.55) independent of age, sex, systolic ejection fraction, and aortic stenosis severity.

    Conclusions
    In patients with aortic stenosis, plasma cTnI concentration is associated with advanced hypertrophy and replacement myocardial fibrosis as well as AVR or cardiovascular death.
    Original languageEnglish
    Pages (from-to)2312-2321
    Number of pages10
    JournalEuropean Heart Journal
    Volume35
    Issue number34
    DOIs
    Publication statusPublished - 7 Sep 2014

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    Cite this

    Chin, C. W. L., Shah, A. S. V., McAllister, D. A., Cowell, S. J., Alam, S., Langrish, J. P., Strachan, F. E., Hunter, A. L., Maria Choy, A., Lang, C. C., Walker, S., Boon, N. A., Newby, D. E., Mills, N. L., & Dweck, M. R. (2014). High-sensitivity troponin I concentrations are a marker of an advanced hypertrophic response and adverse outcomes in patients with aortic stenosis. European Heart Journal, 35(34), 2312-2321. https://doi.org/10.1093/eurheartj/ehu189