The prognostic value of high sensitivity cardiac troponin T in patients with congenital heart disease

Background: Cardiac troponin T (cTnT) is a specific marker of myocardial injury that is elevated in patients with coronary artery disease or heart failure; it has been investigated as a prognostic marker. A highly sensitive, commercially available assay has been developed to detect cardiac troponin T (hs-cTnT). This study aimed to evaluate the clinical implications and prognostic value of hs-cTnT in patients with congenital heart disease (CHD). Methods: We evaluated 122 consecutive patients hospitalized at our institution because of heart failure or scheduled cardiac catheterization. We measured the serum concentration of hs-cTnT at the time of hospitalization, and we prospectively followed-up all patients for 3 years and monitored rates of cardiovascular events (e.g. cardiac death, readmission owing to worsening of heart failure or arrhythmia, and reintervention) as endpoints. Results: We classified the patients according to their hs-cTnT level into non-detectable (ND group, hs-cTnT <0.003 ng/mL), detectable normal (DN group, 0.003 ng/mL <= hs-cTnT <0.014 ng/mL), or elevated (EL group, 0.014 ng/mL <= hs-cTnT) group; 20 of 122 (16.4%) patients were in the EL group, in which 17 cardiovascular events occurred during follow-up. In the multivariate Cox proportional hazard analyses, the EL group [p = 0.024, hazard ratio (HR) 2.7, 95% confidence interval (CI) 1.1-5.8] was an independent significant predictor of cardiovascular events. A Kaplan-Meier curve revealed a high incidence of cardiovascular events in the EL group (EL vs ND log rank p < 0.0001, HR 7.6, 95% CI 3.2-20.0, EL vs DN log rank p < 0.0001, HR 4.1, 95% CI 2.1-7.8). Conclusions: Because the EL group is more likely to have an adverse outcome, elevated hs-cTnT level can be a prognostic marker in patients with CHD. (C) 2017 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.