Interpretation of elevated baseline concentrations and serial changes of high-sensitivity cardiac troponin T in confirmed muscular dystrophies

• Verfasst von: Yildirim, Mustafa [VerfasserIn]
• Verfasst von: Reich, Christoph [VerfasserIn]
• Verfasst von: Salbach, Christian [VerfasserIn]
• Verfasst von: Pribe-Wolferts, Regina [VerfasserIn]
• Verfasst von: Milles, Barbara Ruth [VerfasserIn]
• Verfasst von: Täger, Tobias [VerfasserIn]
• Verfasst von: Müller-Hennessen, Matthias [VerfasserIn]
• Verfasst von: Weiler, Markus [VerfasserIn]
• Verfasst von: Meder, Benjamin [VerfasserIn]
• Verfasst von: Frey, Norbert [VerfasserIn]
• Verfasst von: Giannitsis, Evangelos [VerfasserIn]
• Titel: Interpretation of elevated baseline concentrations and serial changes of high-sensitivity cardiac troponin T in confirmed muscular dystrophies
• Verf.angabe: Mustafa Yildirim, Christoph Reich, Christian Salbach, Regina Pribe-Wolferts, Barbara Ruth Milles, Tobias Täger, Matthias Mueller-Hennessen, Markus Weiler, Benjamin Meder, Norbert Frey and Evangelos Giannitsis
• E-Jahr: 2024
• Jahr: December 2024
• Umfang: 10 S.
• Illustrationen: Illustrationen
• Fussnoten: Online veröffentlicht: 11. Juni 2024 ; Gesehen am 28.01.2025
• Titel Quelle: Enthalten in: European Society of CardiologyESC heart failure
• Ort Quelle: Chichester : Wiley, 2014
• Jahr Quelle: 2024
• Band/Heft Quelle: 11(2024), 6 vom: Dez., Seite 3732-3741
• ISSN Quelle: 2055-5822
• DOI: doi:10.1002/ehf2.14864
• Datenträger: Online-Ressource
• Sprache: eng
• Sach-SW: biological variation
• Sach-SW: ESC 0/1 h algorithm
• Sach-SW: high-sensitivity cardiac troponin
• Sach-SW: skeletal muscle dystrophies
• K10plus-PPN: 1915780985

Abstract

Aims Concentrations of high-sensitivity cardiac troponin T (hs-cTnT) are frequently elevated in stable patients with confirmed muscle dystrophies. However, sparse information is available on the interpretation of serial concentration changes. Methods Hs-cTnT was collected in 35 stable outpatients with confirmed skeletal muscle dystrophies at 0 and 1 h and after 6-12 months during scheduled outpatient visits. We simulated the effectiveness of the European Society of Cardiology (ESC) 0/1 h algorithm and assessed biological variation at 6-12 months using two established methods: reference change value (RCV) and minimal important difference (MID). Results Median baseline hs-cTnT concentrations were 34.4 ng/L [inter-quartile range (IQR): 17.5-46.2], and values > 99th percentile upper limit of normal were present in 34 of 35 patients. All patients were stable without cardiovascular adverse events during a follow-up of 6.6 months (IQR: 6-7). Median concentration change was 1.9 ng/L (IQR: 0.7-3.2) and 0.8 ng/L (IQR: 0-7.0) at 60 min and 6-9 months, respectively. Applying the criteria of the ESC 0/1 h algorithm for triage of suspected acute coronary syndrome (ACS) showed poor overall effectiveness of baseline hs-cTnT values. No patient would qualify for rule-out based on hs-cTnT less than the limit of detection, whereas five cases would qualify for rule-in based on hs-cTnT ≥ 52 ng/L. Biological variabilities at 6-12 months per MID and RCV were 1.2 ng/L [95% confidence interval (CI): 0.7-2.1] and 28.6% (95% CI: 27.9-29.6), respectively. A total of 8 (22.9%) and 25 (71.4%) cases exceeded the biological variation range, suggesting some additional myocardial damage. Conclusions The high prevalence of elevated hs-cTnT could negatively impact the effectiveness of rule-out and rule-in strategies based on a single hs-cTnT value. Knowledge of the physiological and biological variation of hs-cTnT after 6-12 months is helpful to detect the progression of cardiac involvement or to search for cardiac complications including but not limited to arrhythmias that may trigger acute or chronic myocardial damage.