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PLoS One. 2018 Sep 25;13(9):e0204683. doi: 10.1371/journal.pone.0204683. eCollection 2018.

Dynamics of high-sensitivity cardiac troponin T during therapy with balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension.

Author information

Kerckhoff Heart and Thorax Center, Department of Cardiology, Bad Nauheim, German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Frankfurt am Main, Germany.
Kerckhoff Heart and Thorax Center, Department of Thoracic Surgery, Bad Nauheim, Germany.
Justus Liebig University Giessen, Department of Radiology, Giessen, Germany.
Gesundheitszentrum Wetterau, Department of Radiology, Bad Nauheim, Germany.
Justus Liebig University Giessen, Medical Clinic I, Division of Cardiology, Giessen, Germany.
Justus Liebig University of Giessen, Department of Internal Medicine, Division of Pulmonology, Giessen, Germany.



Balloon pulmonary angioplasty (BPA) is an interventional treatment modality for inoperable chronic thromboembolic pulmonary hypertension (CTEPH). Therapy monitoring, based on non-invasive biomarkers, is a clinical challenge. This post-hoc study aimed to assess dynamics of high-sensitivity cardiac troponin T (hs-cTnT) as a marker for myocardial damage and its relation to N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels as a marker for cardiac wall stress.


This study included 51 consecutive patients who underwent BPA treatment and completed a 6-month follow-up (6-MFU) between 3/2014 and 3/2017. Biomarker measurement was performed consecutively prior to each BPA and at 6-MFU. In total, the 51 patients underwent an average of 5 BPA procedures. The 6-month survival rate was 96.1%. The baseline (BL) meanPAP (39.5±12.1mmHg) and PVR (515.8±219.2dyn×sec×cm-5) decreased significantly within the 6-MFU (meanPAP: 32.6±12.6mmHg, P<0.001; PVR: 396.9±182.6dyn×sec×cm-5, P<0.001). At BL, the median hs-cTnT level was 11 (IQR 6-16) ng/L and the median NT-proBNP level was 820 (IQR 153-1872) ng/L. The levels of both biomarkers decreased steadily after every BPA, showing the first significant difference after the first procedure. Within the 6-MFU, hs-cTnT levels (7 [IQR 5-12] ng/L; P<0.001) and NT-proBNP levels (159 [IQR 84-464] ng/l; P<0.001) continued to decrease. The hs-cTnT levels correlated with the PVR (rrs = 0.42; p = 0.005), the meanPAP (rrs = 0.32; p = 0.029) and the NT-proBNP (rrs = 0.51; p<0.001) levels at BL.


Non-invasive biomarker measurement provides valuable evidence for the decreasing impairment of myocardial function and structure during BPA therapy. Changes in hs-cTNT levels are suggestive for a reduction in ongoing myocardial damage.

[Indexed for MEDLINE]
Free PMC Article

Conflict of interest statement

CBW received consultant honoraria and/or speaker fees from Actelion, Bayer AG, MSD, Pfizer and BTG; MH received lecture honoraria from Daiichi-Sankyo and Pfizer; TK received speaker fees from Abbott; SG received speaker fees from Actelion, Bayer, GSK and Pfizer; AR received lecture honoraria from Astra Zeneca, Boehringer Ingelheim and Pfizer-Bristol-Myers Squibb; CWH received lecture or consulting honoraria from Astra Zeneca, Bayer, Boehringer Ingelheim, GSK, Daiichi-Sankyo and Pfizer-Bristol-Myers Squibb; EM received lecture or consulting honoraria from Actelion, Bayer, MSD, GSK, Pfizer and MSD; CL received lecture or consulting honoraria from Abbott, Astra Zeneca, Bayer, Berlin Chemie, Boehringer Ingelheim, Daiichi-Sankyo and Pfizer-Bristol-Myers Squibb. AJR received speaker fees from Servier, St. Jude Medical and Actelion, honoraria from Novartis and traveling support by Orion Pharma and Actelion. SDK, JSW, RA, DB, KP, AB, and FCR have nothing to declare. This does not alter the authors’ adherence to PLOS ONE policies on sharing data and materials.

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