Clinical and echocardiographic correlates of elevated troponin in amyloid light-chain cardiac amyloidosis Journal Article

Authors: Apridonidze, T.; Steingart, R. M.; Comenzo, R. L.; Hoffman, J.; Goldsmith, Y.; Bella, J. N.; Landau, H.; Liu, J. E.
Article Title: Clinical and echocardiographic correlates of elevated troponin in amyloid light-chain cardiac amyloidosis
Abstract: Increased troponin is associated with poor survival in patients with amyloid light-chain (AL) amyloidosis with cardiac involvement (CAL). The purpose of this investigation was to define the relation between increased troponin and clinical, morphologic, and functional features. The comparative utility of clinical, echocardiographic, and biochemical measurements in predicting survival in CAL was also investigated. One hundred seventeen patients with CAL were divided into 2 groups: normal troponin I (<0.06 ng/ml, n = 42) or increased troponin I (<0.06 ng/ml, n = 75). Patients in the high troponin I group were older (63 vs 58 years, p = 0.04), with higher B-type natriuretic peptide levels (1,417 vs 936 pg/ml, p = 0.0004). The high troponin I group also had higher echocardiography-determined early/late mitral inflow velocity ratio (2.2 vs 1.4, p = 0.005) and myocardial performance index (0.59 vs 0.45, p = 0.04) and lower stroke index (28 vs 38 ml/beat/m 2, p <0.0001) and left atrial systolic force (5.9 vs 8.4 k-dynes, p = 0.037) than the normal troponin group. Median survival was significantly shorter in the high troponin group (11 vs 45 months, p <0.001). At time of CAL diagnosis, univariate predictors of all-cause mortality included increased troponin, older age, male gender, New York Heart Association class III to IV, >2 organs involved, higher B-type natriuretic peptide, lower creatinine clearance, greater ventricular septal thickness, and higher myocardial performance index. However, by multivariate Cox survival analysis, only increased troponin was a significant predictor for all-cause mortality (hazard ratio 3.1, p = 0.002). In conclusion, increased troponin is associated with worse left ventricular and left atrial functions by echocardiography in patients with CAL. Among baseline variables, it is the strongest predictor of all-cause mortality in multivariate analysis. Troponin is a powerful tool in clinical and prognostic assessments of patients with CAL. © 2012 Elsevier Inc.
Keywords: survival; adult; controlled study; aged; middle aged; survival rate; major clinical study; mortality; biological markers; proportional hazards models; clinical assessment; amyloidosis; light chain; biopsy; morphology; correlation analysis; proportional hazards model; cardiovascular diseases; chi-square distribution; hazard ratio; echocardiography; univariate analysis; biochemistry; electrocardiography; brain natriuretic peptide; troponin i; heart amyloidosis; heart muscle; flow rate; heart beat; cerebrovascular accident; creatinine clearance; heart left ventricle function; troponin; cardiac patient; amyloid a protein; natriuretic peptide, brain; echocardiography, doppler
Journal Title: American Journal of Cardiology
Volume: 110
Issue: 8
ISSN: 0002-9149
Publisher: Excerpta Medica Inc  
Date Published: 2012-10-15
Start Page: 1180
End Page: 1184
Language: English
DOI: 10.1016/j.amjcard.2012.05.061
PROVIDER: scopus
PUBMED: 22770934
Notes: --- - "Export Date: 2 November 2012" - "CODEN: AJCDA" - "Source: Scopus"
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MSK Authors
  1. Jennifer Liu
    37 Liu
  2. Richard M Steingart
    115 Steingart
  3. Heather Jolie Landau
    187 Landau