High-sensitivity troponin T in asymptomatic severe aortic stenosis

• Published in: Biomarkers 2019-05, Vol.24 (4), p.334-340
• Main Authors: Ferrer-Sistach, Elena, Lupón, Josep, Cediel, Germán, Teis, Albert, Gual, Francisco, Serrano, Sílvia, Vallejo, Nuria, Juncà, Gladys, López-Ayerbe, Jorge, Bayés-Genís, Antoni
• Format: Article
• Language: English
• Subjects: aortic stenosis; Cardiovascular disease; high-sensitiviy troponin T; troponin
• ISSN: 1354-750X; 1366-5804
• DOI: 10.1080/1354750X.2019.1567818

Background: In asymptomatic severe aortic stenosis (ASAS), treatment decisions are made on an individual basis, and case management presents a clinical conundrum. Methods: We prospectively phenotyped consecutive patients with ASAS using echocardiography, exercise echocardiography, cardiac MRI and biomarkers (NT-proBNP, high-sensitivity troponin T (hs-TnT) and ST2) (n = 58). The primary endpoint was a composite of cardiovascular death, new-onset symptoms, cardiac hospitalization, guideline-driven indication for valve replacement and cardiovascular death at 12 months. Results: During the first year, 46.6% patients met primary endpoint. In multivariable analysis, aortic regurgitation ≥2 (p = 0.01) and hs-TnT (p = 0.007) were the only independent predictors of the primary endpoint. The best cutoff value was identified as hs-TnT >10ng/L, which was associated with a ∼10-fold greater risk of the primary endpoint (HR, 9.62; 95% CI, 2.27-40.8; p = 0.002). A baseline predictive model including age, sex and variables showing p 10ng/L was associated with high risk of events within 12 months. Including hs-TnT in routine ASAS management markedly improved prediction metrics.