Cardiac troponin T may be cardiac sarcoidosis prognosis biomarker
Patients with elevated hs-cTnT, BNP had 3.5 times higher risk of adverse events
Blood levels of high-sensitivity cardiac troponin T (hs-cTnT), a marker of heart muscle damage, may serve as a prognostic biomarker for adverse events, including death and heart failure, in people with cardiac sarcoidosis, a study in Japan shows.
Patients with combined elevated levels of both hs-cTnT and B-type natriuretic peptide (BNP), another marker of heart damage, had a 3.5 times higher risk of having adverse events, than those with lower levels of both markers.
“In patients with CS, a high hs-cTnT level is a useful predictor of adverse events,and combined measurement of hs-cTnT and BNP further improves the prognostic value,” the researchers wrote. The study, “Prognostic role of high-sensitivity cardiac troponin T in patients with cardiac sarcoidosis: insights from ILLUMINATE-CS,” was published in ECS Heart Failure.
In sarcoidosis, clumps of abnormally activated immune cells, called granulomas, form, most often in the lungs and lymph nodes. The disease may also affect the heart and lead to symptoms like chest pain, enlargement of the right ventricle, and cardiomyopathy, a condition that affects the heart muscle and makes it harder for the heart to pump blood.
Cardiac troponins have been reported as useful markers to predict adverse outcomes in people with cardiomyopathies. To see if these biomarkers could be a prognostic marker in cardiac sarcoidosis, researchers in Japan analyzed data from a the ILLUMINATE-CS clinical trial, which investigated the clinical characteristics and outcomes of patients with cardiac sarcoidosis.
Higher cardiac troponin T and greater adverse event risk
Among 512 participants in the registry, 103 patients — mainly women (68.9%) who were a mean age of 62.2, had available data on the levels of hs-cTnT at diagnosis. In more than half (57.3%), protein levels were elevated, as defined as a value above 14 nanograms per liter (ng/L).
Patients were divided into two groups, high and low, according to their median levels of hs-cTnT.
Those with high hs-cTnT were older and mostly men. They also most frequently had heart failure and lower ejection fraction, which is the heart’s ability to pump oxygen-rich blood out to the body, worse kidney function, and higher BNP levels.
Over a median follow-up period of 2.6 years, 24 adverse events were reported, which included all-cause mortality (nine patients), fatal ventricular arrhythmia (18 patients), and hospitalization due to heart failure (five events). Fatal ventricular arrhythmia is characterized by a dangerously rapid heart rate that impairs the heart’s ability to supply oxygenated blood to the body. The combined outcome of these events was defined as the primary outcome of the study.
Overall, high levels of hs-TNT were significantly associated with a higher incidence of the primary outcome and all-cause death. A similar result was observed when patients were divided into two groups, high and low, according to their mean BNP value.
After adjusting for factors such as age, sex, and kidney function, having higher hs-cTNT levels was associated with a worse prognosis, or a risk about 4.4 times higher of developing adverse events, while the risk was 3.1 times higher for patients with elevated BNP levels. Patients with both elevated hs-cTNT and BNP levels were 3.5 times more likely to have a primary adverse event than those with low levels of both markers.
The researchers said the “interpretation of hs-cTnT is simple and objective. Furthermore, hs-cTnT is a biomarker that can be measured at low cost and in a serial manner. These facts could potentially alter the management strategies for [cardiac sarcoidosis].”
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