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Relationship of cardiac troponin to systolic global longitudinal strain in hypertrophic cardiomyopathy
Author(s) -
Agarwal Anushree,
Yousefzai Rayan,
Shetabi Kambiz,
Samad Fatima,
Aggarwal Saurabh,
Cho Chi,
Bush Michelle,
Jan M. Fuad,
Khandheria Bijoy K.,
Paterick Timothy E.,
Tajik A. Jamil
Publication year - 2017
Publication title -
echocardiography
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.404
H-Index - 62
eISSN - 1540-8175
pISSN - 0742-2822
DOI - 10.1111/echo.13645
Subject(s) - cardiology , medicine , troponin i , hypertrophic cardiomyopathy , troponin , population , cardiomyopathy , mitral regurgitation , heart failure , myocardial infarction , environmental health
Background A high proportion of stable hypertrophic cardiomyopathy ( HCM ) patients have elevated serum cardiac troponin I ( cTnI ), but its clinical and echocardiographic determinants are unknown. Our objective was to determine the prevalence and clinical predictors of positive troponin ( cTnI +) in a well‐defined population of HCM patients using a highly sensitive assay. Methods We retrospectively interrogated medical records of 167 stable HCM patients from 1/2011 to 3/2014. cTnI >0.04 ng/ mL was considered positive. Results Thirty‐four percent were troponin‐positive (median cTnI was 0.1 [0.07, 0.2] ng/ dL ). cTnI as a continuous variable correlated positively with maximal left ventricular wall thickness ( LVT ), maximal interventricular septal thickness, and global longitudinal strain ( GLS ) ( P <.001). Unadjusted OR (95% CI ) for positive troponin was 0.5 (0.3–0.9, P =.05) for obstructive HCM , 3.2 (1.7–5.9, P <.0001) for increased LVT , 0.3 (0.2–0.6, P <.0001) for −5% increase in GLS , 0.2 (0.04–0.9, P =.04) for moderate‐to‐severe mitral regurgitation, and 1.9 (0.9–3.9, P =.06) for implantable cardioverter defibrillator history. After adjusting for these variables, only maximum LVT ( OR 2.5 [95% CI : 1.1–5.7, P =.02]) and GLS ( OR 0.3 [95% CI : 0.2–0.6, P =.001]) were independent predictors. The percentage of patients with a positive cTnI increased from 19% to 24% and 57% across tertiles of LVT ( P =.003) and decreased from 54% to 33% and 14% across tertiles of GLS ( P <.0001). Conclusion In this cohort of HCM patients, the association of reduced GLS and positive troponin was independent of LVT . Further studies are warranted to evaluate whether their combination adds prognostic value in identifying high‐risk patients to define effective and early intervention strategies.