Key result
Combined CAD and elevated hs-cTnT linked to ~400% higher MACE risk in HCM.
Why the study?
The study was performed to investigate the clinical significance of combined evaluation of both CAD and hs-cTnT for prediction of MACEs in patients with HCM.
Does the combined evaluation of coronary artery disease and hs-cTnT predict major adverse cardiovascular events in patients with hypertrophic cardiomyopathy?
Cohort (n=162)
No
Does the combined evaluation of coronary artery disease and hs-cTnT predict major adverse cardiovascular events in patients with hypertrophic cardiomyopathy?
Effect estimate: HR 5.0 (95% CI 1.0-23.8)
Absolute Event Rate: 10.4% vs 2%
p-value: p=0.046
In patients with hypertrophic cardiomyopathy, the combined presence of coronary artery disease and elevated hs-cTnT is a strong predictor of major adverse cardiovascular events, offering better risk stratification than either marker alone.
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May refine MACE risk stratification in hypertrophic cardiomyopathy; hypothesis-generating and requires prospective validation.
BACKGROUND: This study was performed to investigate the clinical significance of combined evaluation of both coronary artery disease (CAD) and high-sensitivity cardiac troponin T (hs-cTnT) for prediction of major adverse cardiovascular events (MACEs) in patients with hypertrophic cardiomyopathy (HCM). METHODS: We performed clinical evaluations, including coronary artery imaging and hs-cTnT measurement, in 162 patients with HCM. RESULTS: The patients were followed up for a median period of 3.7 years (interquartile range 2.4-5.6 years; total of 632.3 person-years [PYs]), during which time MACEs occurred in 24 (14.8%) patients. The incidence of MACEs was 6.4 and 2.7 per 100 PYs for patients with CAD and normal coronary arteries, respectively; similarly, the incidence was 5.8 and 2.1 per 100 PYs in patients with an elevated hs-cTnT concentration (> 14.0 ng/L) and a normal hs-cTnT concentration, respectively. The multivariate analysis suggested that CAD and an elevated hs-cTnT concentration tended to be positively associated with MACEs. When the groups were allocated according to these two markers, the patients were divided into four groups, which further improved the predictive values. The incidence of MACEs was 10.4 per 100 PYs in the CAD and elevated hs-cTnT group, which was much higher than the incidence in all other groups (range, 2.0-3.5 per 100 PYs). With the normal coronary arteries and normal hs-cTnT group serving as a reference, the adjusted hazard ratio was 5.0 (95% confidence interval 1.0-23.8; P = 0.046) for the CAD and elevated hs-cTnT group. In addition, the subgroup analysis showed similar findings among the patients without severe CAD. CONCLUSIONS: In patients with HCM, combined evaluation of both CAD and hs-cTnT might facilitate more reliable prediction of MACEs than evaluation of a single marker. These may serve as clinically useful markers to guide risk management.
Liao et al. (2021) conducted a cohort in Hypertrophic cardiomyopathy (n=162). Combined coronary artery disease and elevated high-sensitivity cardiac troponin T vs. Normal coronary arteries and normal high-sensitivity cardiac troponin T was evaluated on Major adverse cardiovascular events (MACEs) (HR 5.0, 95% CI 1.0-23.8, p=0.046). Combined coronary artery disease and elevated high-sensitivity cardiac troponin T significantly increased the risk of major adverse cardiovascular events (HR 5.0) in hypertrophic cardiomyopathy.