Format

Send to

Choose Destination
Am J Cardiol. 2019 Dec 15;124(12):1932-1939. doi: 10.1016/j.amjcard.2019.09.014. Epub 2019 Sep 26.

Long-Term Prognostic Value of High-Sensitivity Troponin T Added to N-Terminal Pro Brain Natriuretic Peptide Plasma Levels Before Valve Replacement for Severe Aortic Stenosis.

Author information

1
University Clinic of Internal Medicine III, Medical University Innsbruck, Innsbruck, Austria.
2
Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
3
University Clinic of Heart Surgery, Medical University Innsbruck, Innsbruck, Austria.
4
Department of Cardiology, Kepler University Hospital, Medical Faculty, Johannes Kepler University Linz, Austria.
5
Department of Internal Medicine, Division of Cardiology, Medical University Graz, Graz, Austria.
6
University Clinic of Internal Medicine II, Paracelsus Medical University, Salzburg, Austria.
7
University Clinic of Radiology, Medical University Innsbruck, Innsbruck, Austria.
8
Institute of Clinical Epidemiology, Tirol Kliniken, Innsbruck, Austria; Institute of Electrical and Biomedical Engineering, University for Health Sciences, Medical Informatics and Technology (UMIT), Hall in Tirol, Austria.
9
University Clinic of Internal Medicine III, Medical University Innsbruck, Innsbruck, Austria. Electronic address: dichtl@me.com.

Abstract

Natriuretic peptide plasma levels help to manage patients with severe aortic stenosis (AS). The role of troponin plasma levels in this patient cohort remains speculative. A consortium of 4 university hospital centers in Austria analyzed retrospectively 3,595 patients admitted for valve replacement because of severe AS since 2007. The aim was to compare the additive preprocedural value of high-sensitivity troponin T (hsTnT) to N-terminal pro brain natriuretic peptide (NT-proBNP) plasma levels in predicting postoperative long-term survival in a large cohort undergoing either surgical (57.8%) or transcatheter (42.2%) aortic valve replacement. During a median follow-up of 2.93 (1.91 to 4.92) years, 919 patients (25.6%) died, in them 556 (15.5%) due to cardiovascular causes. Both normal hsTnT (<14 ng/l) and NT-proBNP (within age- and sex-corrected normal range) plasma levels were found in 481 patients (14.3%, group 1). Normal hsTnT but elevated NT-proBNP plasma levels were found in 748 patients (22.3%, group 2). Elevated hsTnT but normal NT-proBNP plasma levels were found in 258 patients (7.7%, group 3). Both elevated hsTnT and elevated NT-proBNP plasma levels were found in 1,869 patients (55.7%, group 4). Using Log Rank tests for comparison there was a highly significant difference in both cardiovascular mortality (p <0.0001) and all-cause mortality (p <0.0001). All-cause mortality rates after 1, 3, and 5 years were 2.1%, 5.4%, 7.7% in group 1; 4.0%, 7.5%, 11.5% in group 2; 5.8%, 8.9%, 14.0% in group 3; and 12.3%, 22.6%, 28.4% in group 4. In conclusion, hsTnT adds additional impact to NT-proBNP as a routinely available biomarker for risk stratification concerning postoperative survival in patients with severe AS admitted for valve replacement. The present study supports the concept to integrate hsTnT plasma levels in the management of severe AS.

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center