Detectable Troponin Levels Predict Poor Prognosis in Patients With Left Ventricular Dysfunction Undergoing Internal Defibrillator Implantation

Sonel, Ali F.; Shalaby, Alaa; McConnell, Joseph P.; Czarnecki, R; Hogen, Scott; Zahid, Maliha; Amidi, Morteza

doi:10.1111/j.1540-8159.2007.00770.x

Cited by 8 publications

(7 citation statements)

References 35 publications

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“…Such myocardial metabolic “fragility” identified by troponin elevations might also explain the reported adverse prognostic impact of raised serum troponin levels in diverse populations such as those with renal failure6 7 or heart failure,8 9 patients undergoing percutaneous10 and surgical revascularisation11 and even elderly subjects in the general population 12. Recently, Sonel et al showed that the presence of detectable cTnT before ICD implantation is associated with a higher subsequent mortality,13 suggesting that pre-implant cTnT levels might be used for risk stratification. Our data add to these at-risk patient populations those who have cTnT elevation after ICD discharge.…”

Section: Discussionmentioning

confidence: 99%

“…Troponin elevation in serum has been reported to be associated with adverse outcome in diverse populations, including survivors of non-ST-elevation myocardial infarction5; those with renal failure6 7 or heart failure8 9; patients undergoing percutaneous10 or surgical revascularisation11; and, in a study by Zethelius et al , even in a community-based cohort of 70-year-old men 12. Among ICD recipients, Sonel et al demonstrated that a raised troponin level before ICD implant was an independent marker for increased mortality 13. These investigators did not examine troponin release after ICD discharges.…”

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confidence: 99%

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Troponin T elevation after implanted defibrillator discharge predicts survival

Blendea

Banker

et al. 2009

Heart

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Troponin T elevation after implanted defibrillator discharge predicts survival

Blendea

Banker

et al. 2009

Heart

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“…Patients were divided into groups based on detectable TnT or elevated BNP. Cut points of 0.01 ng/mL for TnT and 440 pg/mL BNP were predefined based on previously published studies of BNP and TnT in similar cohorts. Patients were divided into a low‐risk group who had no detectable TnT and low BNP, intermediate‐risk with either detectable TnT or elevated BNP, and high risk with both detectable TnT and elevated BNP.…”

Section: Data Analysis and Statistical Methodsmentioning

confidence: 99%

“…Among patients with cardiomyopathy, elevated levels of either biomarker, particularly in the face of optimal therapy, have been associated with worse prognosis . In combination, these biomarkers provide significant prognostic information; however, their value has not been explored among CRT‐D recipients …”

Section: Introductionmentioning

confidence: 99%

Association of BNP and Troponin Levels with Outcome among Cardiac Resynchronization Therapy Recipients

Shalaby

Abraham

Fonarow

et al. 2015

Pacing Clinical Electrophis

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Introduction We conducted a prospective multicenter study to assess the prognostic value of combined baseline pre-implant plasma levels of the biomarkers cardiac troponin T (TnT) and BNP among CRT-D recipients. Methods At CRT-D implant, patients were stratified based on detectable TnT (≥0.01 ng/ml) and elevated BNP (predefined as >440 pg/ml) levels. Patients were classified into 3 groups high (both detectable TnT and high BNP), intermediate (either detectable TnT or high BNP), or low (non-detectable TnT and low BNP). Patients were followed for 12 months. Survival curves free from mortality or HFH were assessed. To assess the predictive value of biomarker category, we constructed a multivariate Cox regression model, including the covariates of age, NYHA class, LVEF, and QRS duration. Results A total of 267 patients (age 66 ± 12 years, males 80%, LVEF 25% ± 8%, ischemic CM 52%, QRSd 155 ± 26 ms) were studied. After one year, there were 13 deaths and 25 HFH events. A significant difference in event free survival among the 3 groups was observed, with high and intermediate categories having worse survival than low (log-rank test, p <0.001). In the multivariate model, risk category was a significant predictor of outcome: Hazard ratios were 7.34 (95% CI: 2.48 to 21.69) and 2.50 (95% CI: 1.04 to 6.04) for high and intermediate risk groups respectively (p<0.0001). Conclusion Among CRT-D recipients, baseline TnT and BNP values alone or in combination provide significant prognostic value for the outcome of mortality or HFH.

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“…In patients with additional intraoperative defibrillation threshold testing, elevated troponin levels were more commonly detected than in patients without defibrillation threshold testing. In other entities, such as heart failure, acute coronary syndroms, stable coronary artery disease and atrial fibrillation, elevated levels of Troponin have not only been shown to be associated with myocardial microdamage but also with increased mortality and morbidity [7][8][9] . By randomizing patients either to an ICD implantation without intraoperative ATP or to an ICD implantation with intraoperative ATP, we aimed to characterize myocardial microdamage caused by ATP.…”

Section: Discussionmentioning

confidence: 99%

Myocardial Minimal Damage After Rapid Ventricular Pacing – the prospective randomized multicentre MyDate-Trial

Semmler

Deutschmann

Haller

et al. 2020

Sci Rep

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therapy of choice for the primary and secondary prevention of sudden cardiac death is the implantation of an implantable cardioverter defibrillator (ICD). Whereas appropriate and inappropriate ICD shocks lead to myocardial microdamage, this is not known for antitachycardia pacing (ATP). In total, 150 ICD recipients (66 ± 12 years, 81.3% male, 93.3% primary prevention, 30.0% resynchronization therapy) were randomly assigned to an ICD implantation with or without intraoperative ATP. In the group with ATP, the pacing maneuver was performed twice, each time applying 8 impulses 6 Volt x 1.0 milliseconds to the myocardium. High sensitive Troponin T (hsTnT) levels were determined prior to the implantation and thereafter. There was no significant difference in the release of hsTnT between the two randomization groups (delta TnT without ATP in median 0.010 ng/ml [min. −0.016 ng/ml-max. 0.075 ng/ml] vs. with ATP in median 0.013 ng/ml [min. −0.005-0.287 ng/ml], p = 0.323). Setting a hsTnT cutoff of 0.059 ng/dl as a regularly augmented postoperative hsTnT level, no relevant difference between the two groups regarding the postoperative hsTnT levels above this cutoff could be identified (without ATP n = 10 [14.7%] vs. with ATP n = 16 [21.9%], p = 0.287). There was no significant difference in the release of high sensitive troponin between patients without intraoperative Atp compared to those with intraoperative ATP. Hence, antitachycardia pacing does not seem to cause significant myocardial microdamage. This may further support its use as a painless and efficient method to terminate ventricular tachycardia in high-risk patients.

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Detectable Troponin Levels Predict Poor Prognosis in Patients With Left Ventricular Dysfunction Undergoing Internal Defibrillator Implantation

Abstract: In a cohort of patients with cardiomyopathy undergoing ICD implantation for standard clinical indications, presence of detectable TnT was associated with high mortality despite ICD implantation. TnT obtained before ICD implantation may be useful for risk stratification.

Cited by 8 publications

References 35 publications

Troponin T elevation after implanted defibrillator discharge predicts survival

Troponin T elevation after implanted defibrillator discharge predicts survival

Association of BNP and Troponin Levels with Outcome among Cardiac Resynchronization Therapy Recipients

Myocardial Minimal Damage After Rapid Ventricular Pacing – the prospective randomized multicentre MyDate-Trial

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