Elevation of High-Sensitivity Cardiac Troponin T and Left Ventricular Remodelling in Hypertrophic Cardiomyopathy

AIMS: Hypertrophic cardiomyopathy (HCM) is generally associated with mild disability and normal life expectancy. On the other hand, once the end-stage phase of HCM characterized by left ventricular (LV) ejection fraction < 50% is established, patients with this subtype have a poor prognosis. This study clarifies the clinical parameters associated with progression to end-stage HCM. METHODS AND RESULTS: We retrospectively studied 157 HCM patients (age 59.9 ± 14.2 years, 104 men) with preserved LV systolic function in whom subsequent echocardiographic data were obtained for a period of >1 year. HCM progressed to end-stage HCM in 13 patients (8.3%) of the 157 patients during a mean follow-up period of 6.3 ± 2.8 years. Compared with patients who did not reach end-stage HCM at the last evaluation, patients with progression to the end-stage phase had lower ejection fraction, larger LV size, more enlarged left atrial diameter, longer follow-up period, and higher frequency of an elevated concentration of high-sensitivity cardiac troponin T (hs-cTnT; >0.014 ng/mL) at registration. Multivariate analysis revealed that elevated hs-cTnT was a significant predictor independent of lower LV ejection fraction for progression to end-stage HCM. Furthermore, in patients with elevated hs-cTnT levels, LV ejection fraction became significantly lower, LV end-diastolic diameter increased, and LV wall thickness decreased during the follow-up period, whereas those parameters did not change in the normal hs-cTnT group. CONCLUSIONS: In patients with HCM, an elevated hs-cTnT was associated with progression of LV remodelling, and this biomarker can be useful for predicting progression to the end-stage phase.