1. High-sensitivity troponin T in asymptomatic severe aortic stenosis.
- Author
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Ferrer-Sistach E, Lupón J, Cediel G, Teis A, Gual F, Serrano S, Vallejo N, Juncà G, López-Ayerbe J, and Bayés-Genís A
- Subjects
- Aged, Aged, 80 and over, Aortic Valve Insufficiency diagnostic imaging, Aortic Valve Insufficiency etiology, Aortic Valve Insufficiency mortality, Aortic Valve Stenosis complications, Aortic Valve Stenosis diagnostic imaging, Aortic Valve Stenosis mortality, Area Under Curve, Asymptomatic Diseases, Biomarkers blood, Echocardiography, Female, Humans, Interleukin-1 Receptor-Like 1 Protein blood, Magnetic Resonance Imaging, Male, Middle Aged, Multivariate Analysis, Natriuretic Peptide, Brain blood, Peptide Fragments blood, Prognosis, Prospective Studies, Risk Assessment, Severity of Illness Index, Survival Analysis, Aortic Valve Insufficiency blood, Aortic Valve Stenosis blood, Troponin T blood
- Abstract
Background: In asymptomatic severe aortic stenosis (ASAS), treatment decisions are made on an individual basis, and case management presents a clinical conundrum. Methods: We prospectively phenotyped consecutive patients with ASAS using echocardiography, exercise echocardiography, cardiac MRI and biomarkers (NT-proBNP, high-sensitivity troponin T (hs-TnT) and ST2) ( n = 58). The primary endpoint was a composite of cardiovascular death, new-onset symptoms, cardiac hospitalization, guideline-driven indication for valve replacement and cardiovascular death at 12 months. Results: During the first year, 46.6% patients met primary endpoint. In multivariable analysis, aortic regurgitation ≥2 ( p = 0.01) and hs-TnT ( p = 0.007) were the only independent predictors of the primary endpoint. The best cutoff value was identified as hs-TnT >10ng/L, which was associated with a ∼10-fold greater risk of the primary endpoint (HR, 9.62; 95% CI, 2.27-40.8; p = 0.002). A baseline predictive model including age, sex and variables showing p < 0.10 in univariable analyses showed an area under the curve (AUC) of 0.79(0.66-0.91). Incorporation of hs-TnT into this model increased the AUC to 0.90(0.81-0.98) ( p = 0.03). Patient reclassification with the model including hs-TnT yielded an NRI of 1.28(0.46-1.78), corresponding to 43% adequately reclassified patients. Conclusions: In patients with ASAS, hs-TnT >10ng/L was associated with high risk of events within 12 months. Including hs-TnT in routine ASAS management markedly improved prediction metrics.
- Published
- 2019
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