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Interpretation of elevated baseline concentrations and serial changes of high-sensitivity cardiac troponin T in confirmed muscular dystrophies.
Yildirim, Mustafa; Reich, Christoph; Salbach, Christian; Pribe-Wolferts, Regina; Milles, Barbara Ruth; Täger, Tobias; Mueller-Hennessen, Matthias; Weiler, Markus; Meder, Benjamin; Frey, Norbert; Giannitsis, Evangelos.
Afiliação
  • Yildirim M; Department of Internal Medicine III, Cardiology, University Hospital of Heidelberg, Heidelberg, Germany.
  • Reich C; Department of Internal Medicine III, Cardiology, University Hospital of Heidelberg, Heidelberg, Germany.
  • Salbach C; Institute for Cardiomyopathies & Center for Cardiogenetics, Department of Medicine III, Heidelberg University, Heidelberg, Germany.
  • Pribe-Wolferts R; Department of Internal Medicine III, Cardiology, University Hospital of Heidelberg, Heidelberg, Germany.
  • Milles BR; Department of Internal Medicine III, Cardiology, University Hospital of Heidelberg, Heidelberg, Germany.
  • Täger T; Department of Internal Medicine III, Cardiology, University Hospital of Heidelberg, Heidelberg, Germany.
  • Mueller-Hennessen M; Department of Internal Medicine III, Cardiology, University Hospital of Heidelberg, Heidelberg, Germany.
  • Weiler M; Department of Internal Medicine III, Cardiology, University Hospital of Heidelberg, Heidelberg, Germany.
  • Meder B; Department of Neurology, University Hospital of Heidelberg, Heidelberg, Germany.
  • Frey N; Department of Internal Medicine III, Cardiology, University Hospital of Heidelberg, Heidelberg, Germany.
  • Giannitsis E; German Centre for Cardiovascular Research (DZHK), Heidelberg, Germany.
ESC Heart Fail ; 2024 Jul 11.
Article em En | MEDLINE | ID: mdl-38992971
ABSTRACT

AIMS:

Concentrations of high-sensitivity cardiac troponin T (hs-cTnT) are frequently elevated in stable patients with confirmed muscle dystrophies. However, sparse information is available on the interpretation of serial concentration changes.

METHODS:

Hs-cTnT was collected in 35 stable outpatients with confirmed skeletal muscle dystrophies at 0 and 1 h and after 6-12 months during scheduled outpatient visits. We simulated the effectiveness of the European Society of Cardiology (ESC) 0/1 h algorithm and assessed biological variation at 6-12 months using two established

methods:

reference change value (RCV) and minimal important difference (MID).

RESULTS:

Median baseline hs-cTnT concentrations were 34.4 ng/L [inter-quartile range (IQR) 17.5-46.2], and values > 99th percentile upper limit of normal were present in 34 of 35 patients. All patients were stable without cardiovascular adverse events during a follow-up of 6.6 months (IQR 6-7). Median concentration change was 1.9 ng/L (IQR 0.7-3.2) and 0.8 ng/L (IQR 0-7.0) at 60 min and 6-9 months, respectively. Applying the criteria of the ESC 0/1 h algorithm for triage of suspected acute coronary syndrome (ACS) showed poor overall effectiveness of baseline hs-cTnT values. No patient would qualify for rule-out based on hs-cTnT less than the limit of detection, whereas five cases would qualify for rule-in based on hs-cTnT ≥ 52 ng/L. Biological variabilities at 6-12 months per MID and RCV were 1.2 ng/L [95% confidence interval (CI) 0.7-2.1] and 28.6% (95% CI 27.9-29.6), respectively. A total of 8 (22.9%) and 25 (71.4%) cases exceeded the biological variation range, suggesting some additional myocardial damage.

CONCLUSIONS:

The high prevalence of elevated hs-cTnT could negatively impact the effectiveness of rule-out and rule-in strategies based on a single hs-cTnT value. Knowledge of the physiological and biological variation of hs-cTnT after 6-12 months is helpful to detect the progression of cardiac involvement or to search for cardiac complications including but not limited to arrhythmias that may trigger acute or chronic myocardial damage.
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Texto completo: 1 Base de dados: MEDLINE Idioma: En Ano de publicação: 2024 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Idioma: En Ano de publicação: 2024 Tipo de documento: Article