(Circulation. 2001;103:369.)
© 2001 American Heart Association, Inc.
Clinical Investigation and Reports |
Persistently Increased Serum Concentrations of Cardiac Troponin T in Patients With Idiopathic Dilated Cardiomyopathy Are Predictive of Adverse Outcomes
From the Division of Cardiology, Department of Internal Medicine, Hyogo Prefectural Amagasaki Hospital, Amagasaki, Hyogo, Japan (Y.S., T.Y., R.T., K.N., T.M., H.O., Y.T.), and Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Sakyo-ku, Kyoto, Japan (K.K., H.I., A.M., S.S.).
Correspondence to Yukihito Sato, MD, Division of Cardiology, Department of Internal Medicine, Hyogo Prefectural Amagasaki Hospital, 1-1-1 Higashi-Daimotsu-Cho, Amagasaki, Hyogo 660-0828, Japan. E-mail satoh{at}amahosp.amagasaki.hyogo.jp
Background—The measurement of serum concentrations of cardiac troponin T (TnT) is a simple, useful method to detect myocyte injury that may be repeated multiple times to follow patients without interobserver variability.
Methods and
Results—Multiple measurements of TnT with a
second-generation assay were performed in 60 patients with dilated
cardiomyopathy confirmed by coronary angiography and endomyocardial
biopsy between April 1996 and December 1999. Three evolutionary
patterns of TnT concentrations were identified. Thirty-three patients
had concentrations of TnT <0.02 ng/mL throughout the follow-up period
(group 1). The remaining 27 patients had high initial serum
concentrations of TnT (
0.02 ng/mL). In 10 of these 27 patients, TnT
decreased to <0.02 ng/mL during follow-up (group 2), whereas 17 had
persistently high serum TnT concentrations despite being conventionally
treated for chronic congestive heart failure (group 3). Although the
initial echocardiographic left ventricular diastolic dimension (LVDd)
and left ventricular ejection fraction (LVEF) were not significantly
different among the 3 groups, follow-up echocardiography showed
significantly decreased LVDd and increased LVEF in group 1 (each
P<0.01) and group 2 (each
P<0.05) compared with
increased LVDd and decreased LVEF in group 3 (each
P<0.05). The cardiac
event-free rate was significantly lower in group 3 than in groups 1 and
2 (each P<0.001), and the
survival rate was lower in group 3 than in group 1
(P<0.05).
Conclusions—Persistently increased TnT concentrations in dilated cardiomyopathy suggest ongoing subclinical myocyte degeneration associated with deterioration of the patients’ clinical status.
Key Words: proteins • cardiomyopathy • heart failure
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