Correlation Between Extent of Myocardial Fibrosis Assessed by Cardiac Magnetic Resonance and Cardiac Troponin T Release in Patients With Nonischemic Heart Failure

Abstract

Persistently high cardiac troponin T (cTnT) levels reflect myocardial damage in heart failure (HF). The presence and extent of myocardial fibrosis assessed by cardiac magnetic resonance (CMR) and high levels of cTnT predict poor prognosis in various cardiomyopathies. However, the association between myocardial fibrosis and transcardiac cTnT release has not been evaluated. This study investigated the correlation between myocardial fibrosis and transcardiac cTnT release from nonischemic failing myocardium. Serum cTnT levels were measured in aortic root (Ao) and coronary sinus (CS) using highly sensitive assay (detection limit >5 ng/L) in 74 nonischemic patients with HF who underwent CMR. Transcardiac cTnT release (ΔcTnT [CS-Ao]) represented the difference between CS and Ao-cTnT levels. Myocardial fibrosis was quantified by late gadolinium enhancement (LGE) volume and %LGE on CMR. cTnT was detectable in 65 patients (88%), and ΔcTnT (CS-Ao) levels were available (ΔcTnT [CS-Ao] >0 ng/L) in 60 patients (81%). LGE was observed in 42 patients (57%), and ΔcTnT (CS-Ao) levels were available in 41 LGE-positive patients (98%). In patients with available cTnT release, ΔcTnT (CS-Ao) levels were significantly higher in LGE-positive patients than those in LGE-negative patients (4.3 [2.2-5.5] vs 1.5 [0.9-2.6] ng/L; p = 0.001). Log (ΔcTnT [CS-Ao]) levels were correlated with LGE volume (r = 0.460, p = 0.003) and %LGE (r = 0.356, p = 0.03). In conclusion, the amount of transcardiac cTnT release was higher in LGE-positive patients than LGE-negative patients and correlated with the extent of LGE in nonischemic patients with HF. These results suggested that ongoing myocardial damage correlates with the presence and extent of myocardial fibrosis.

High-Sensitive Cardiac Troponin T as an Early Biochemical Signature for Clinical and Subclinical Heart Failure

“…31 Studies measuring hs-cTn in symptomatic non-ischemic heart disease populations including non-ischemic cardiomyopathy, hypertrophic cardiomyopathy and severe aortic stenosis, all identified significant associations between the hs-cTn levels and the presence of LGE, most of which was “atypical” in location. 32–34 We expand these findings by showing that hs-cTnT may represent a biomarker surrogate for early myocardial fibrosis in an asymptomatic lower-risk general population free of known cardiovascular disease.…”

Why does Russia have such high cardiovascular mortality rates? Comparisons of blood-based biomarkers with Norway implicate non-ischaemic cardiac damage

“…9 10 Biochemical evidence of myocyte injury was associated with subsequent imaging evidence of replacement fibrosis both in the sample of asymptomatic individuals 9 and in symptomatic non-ischaemic heart disease populations. 28–30 Even in patients with chronic coronary artery disease, hs-cTnT was associated with death and heart failure but not MI. 31 It is notable that exclusion of participants with pre-existing coronary heart disease in our study did not change the estimates of the differences in hs-cTnT substantially, neither did adjustment for hypertension and smoking.…”

Galectin-3 and myocardial fibrosis in nonischemic dilated cardiomyopathy

“…In experimental settings, aldosterone levels are associated with myocardial fibrosis evaluated ex vivo in different hypertensive rat models [18], but these findings have not been confirmed in a cohort of patients with NICM [19]. Likewise, the relationship between cardiac troponin release and myocardial fibrosis is supported by post-mortem studies in humans and by the association between transcardiac troponin T gradient and LGE in patients with NICM [20,21], but it remains elusive.…”