Prognostic Value of Serial High-Sensitivity Troponin T Measurements in Adults With Congenital Heart Disease

Abstract

Background: Single high-sensitivity troponin T (hs-TnT) measurement is predictive of cardiac events in adults with congenital heart disease (ACHD). We aimed to study the prognostic value of serial hs-TnT measurements in stable patients with ACHD. Methods: In total, 602 consecutive patients with ACHD were enrolled in this prospective study (2011)(2012)(2013). Blood sampling was performed at enrollment and thereafter yearly during scheduled visits, up to 4 years. Hs-TnT, N-terminal pro B-type natriuretic peptide (NT-proBNP), and estimated glomerular filtration rate (eGFR) were measured. The composite primary endpoint was defined as all-cause mortality, heart failure, arrhythmia, hospitalization, cardiac (re)interventions, or thromboembolic events. The relationship between changes in serial hs-TnT and the primary endpoint was studied by joint models with adjustment for repeated NT-proBNP and eGFR. Results: In 601 patients (median age, 33 [interquartile range, 25-41] years, 42% women, 90% NYHA I), at least 1 hs-TnT measurement was

Adult patients with congenital heart disease in the intensive care unit

“…The long-term mortality in our study was 12.5% over a follow-up period of 8 years. In comparison, mortality was 4.2% during 6 years of follow-up in an observational cohort of 76% of patients with moderate CHD and 24% of patients with severe CHD from our own tertiary care centre 22. Even accounting for the higher proportion of severe CHD in our study, our mortality rate seems unusually high, suggesting that patients with ACHD needing ICU admission remain at increased risk of mortality even years after the admission.…”

Use of Serial High-Sensitive Troponin T in Patients With Adult Congenital Heart Disease: Enhancing the Detection of Major Adverse Cardiac Events

“…Patients with ACHD are at risk of mortality and MACE. On the basis of the results of the study by Geenen et al, 11 serial hs-TnT measures serve as a prognostic biomarker of all-cause mortality and MACE, thereby risk-stratifying patients. Hs-TNT levels could be used as a critical indicator of adverse clinical outcomes in patients with ACHD, over and above NT-proBNP measures (Fig.…”

“…In this issue of the Canadian Journal of Cardiology, Geenen et al report the results of a prospective study tracking a cohort of patients with ACHD and their clinical outcomes, while simultaneously conducting serial measures of hs-TnT at scheduled follow-up clinic visits, over a 4-year period. 11 From their study, we can conclude that: (1) serial measures of hs-TnT have greater clinical utility than baseline measures of hs-TnT as a prognostic marker for mortality and major adverse cardiac events (MACE) and; (2) ACHD patients with stable measures of hs-TnT are at lower risk of mortality and MACE than patients with dynamic changes (ie, increasing or decreasing) in hs-TnT levels over follow-up. These findings support the clinical utility of serial hs-TnT measures in patients with ACHD, which could potentially improve patient management and surveillance in this patient cohort.…”

“…In their article, Geenen et al describes a prospective, single-centre study to examine the prognostic value of serial hs-TnT measures, in patients with ACHD, for all-cause mortality and MACE. 11 Six hundred two consecutive patients with moderate to complex ACHD were prospectively included in the study. Patients were excluded if they were younger than 18 years old, were diagnosed with mild ACHD (isolated atrial septal defect [ASD] or ventricular septal defect [VSD]), had impaired renal function (defined as creatinine > 200 mmol/L), or were pregnant.…”

“…Geenen et al 11 The prospective evaluation of serial hs-TnT measures in patients with ACHD is a novel initiative. In previous studies the risk of adverse clinical outcomes in patients with ACHD has been stratified using a single baseline measure of hs-TnT, [14][15][16][17] which holds lower prognostic value, and is of limited clinical utility as shown in this study.…”