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J Am Coll Cardiol. 2013 Aug 13;62(7):632-40. doi: 10.1016/j.jacc.2013.03.065. Epub 2013 May 1.

Coronary microvascular dysfunction and diastolic load correlate with cardiac troponin T release measured by a highly sensitive assay in patients with nonischemic heart failure.

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Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.



This study investigated factors associated with cardiac troponin T (cTnT) release from failing myocardium.


Persistent and modest elevation of serum cTnT is frequently observed in heart failure (HF) patients free of coronary artery disease, although the mechanisms underlying this finding remain unclear.


We evaluated serum cTnT levels in the aortic root (Ao) and coronary sinus (CS) using a highly sensitive assay in 90 nonischemic HF patients and 47 non-HF patients. Transcardiac cTnT and plasma B-type natriuretic peptide (BNP) release were described as the differences between CS and Ao cTnT levels [ΔcTnT (CS-Ao)] and BNP levels [ΔBNP (CS-Ao)], respectively. Coronary flow reserve (CFR) was measured in 68 HF patients using an intracoronary Doppler guidewire.


ΔcTnT (CS-Ao) levels were available in 76 HF patients and 28 non-HF patients (84% vs. 60%; p = 0.001), and higher in HF patients than non-HF patients (p < 0.001). Among HF patients, log[ΔcTnT (CS-Ao)] correlated with log[ΔBNP (CS-Ao)] (r = 0.368, p = 0.001), pulmonary capillary wedge pressure (r = 0.253, p = 0.03) and left ventricular end-diastolic pressure (LVEDP) (r = 0.321, p = 0.005). Multivariate regression analysis identified LVEDP as an independent parameter that correlated with ΔcTnT (CS-Ao). ΔcTnT (CS-Ao) levels were available in 58 HF patients who were evaluated for CFR. Coronary microvascular dysfunction, diagnosed by CFR <2.0, was observed in 18 HF patients. ΔcTnT (CS-Ao) was higher in patients with coronary microvascular dysfunction (4.8 [2.0 to 8.1] ng/l) than those without (2.0 [1.2 to 4.6] ng/l; p = 0.04).


cTnT release from failing myocardium correlated with diastolic load and coronary microvascular dysfunction in nonischemic HF patients.


Ao; CAD; CFR; CI; CMVD; CS; FV; IL; LVEDP; OR; TNF; aortic root; cTnT; cardiac troponin T; confidence interval; coronary artery disease; coronary flow reserve; coronary microvascular dysfunction; coronary sinus; femoral vain; heart failure; high-sensitivity C-reactive protein; highly-sensitive troponin T; hs-CRP; hs-TnT; interleukin; left ventricular end-diastolic pressure; natriuretic peptide; odds ratio; troponin; tumor necrosis factor; wall stress

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