Key result
Higher hs-cTnI predicts ~193% greater risk of sudden cardiac death or equivalent events in HCM.
Why the study?
Risk stratification of sudden cardiac death in hypertrophic cardiomyopathy remains challenging, and the relationship between high-sensitivity cardiac troponin I and sudden cardiac death risk is unclear.
Does high-sensitivity cardiac troponin I (hs-cTnI) improve risk stratification for sudden cardiac death in patients with hypertrophic cardiomyopathy?
Cohort (n=559)
Does high-sensitivity cardiac troponin I (hs-cTnI) improve risk stratification for sudden cardiac death in patients with hypertrophic cardiomyopathy?
Hazard Ratio: 2.93 (95% CI 1.89–4.54)
p-value: p=< .0001
High-sensitivity cardiac troponin I is an independent predictor of sudden cardiac death in hypertrophic cardiomyopathy and significantly improves the predictive performance of conventional risk stratification models.
hs-cTnI may enhance SCD risk stratification in HCM cohorts; leaves open prospective validation before clinical adoption.
BACKGROUND: Risk stratification of sudden cardiac death (SCD) in hypertrophic cardiomyopathy (HCM) remains challenging. High-sensitivity cardiac troponin I (hs-cTnI) specifically reflects myocardial damage whereas its relationship with SCD risk in HCM is unclear. OBJECTIVE: This study aimed to investigate the prognostic value of hs-cTnI on enhancing SCD risk stratification in HCM. METHODS: This cohort study consecutively enrolled 705 patients with confirmed diagnosis of HCM. The baseline and clinical follow-up data were collected. The primary end point was defined as SCD or SCD-equivalent events including witnessed arrhythmic cardiac arrest and sustained ventricular tachycardia or ventricular fibrillation requiring intervention. RESULTS: The final analysis included 559 patients with a mean age of 53.0 years, 66.2% male, 16.1% with an implantable cardioverter-defibrillator (ICD), and a mean hs-cTnI level of 0.021 ng/mL. The mean follow-up was 862 days, with 51 patients (9.1%) experiencing SCD events. hs-cTnI showed a significant nonlinear association with SCD risk and remained as an independent predictor (adjusted hazard ratio 2.93 [95% confidence interval 1.89‒4.54], P < .0001). The optimal threshold value of hs-cTnI for increased risk of SCD was 0.0405 ng/mL. The addition of hs-cTnI to the conventional risk score model significantly improved the predictive performance (C-statistic increased from 0.752 to 0.813; P = .007). Patients with both elevated risk score and hs-cTnI had the worst prognosis (P < .0001). CONCLUSION: hs-cTnI could be an independent predictor of SCD risk for patients with HCM. Integrating hs-cTnI into SCD risk assessment may provide additional indication of ICD implantation for primary prevention.
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Lai et al. (2026) conducted a cohort in Hypertrophic cardiomyopathy (n=559). High-sensitivity cardiac troponin I (hs-cTnI) was evaluated on SCD or SCD-equivalent events including witnessed arrhythmic cardiac arrest and sustained ventricular tachycardia or ventricular fibrillation requiring intervention (adjusted HR 2.93, 95% CI 1.89-4.54, p=< .0001). High-sensitivity cardiac troponin I was an independent predictor of sudden cardiac death or equivalent events in patients with hypertrophic cardiomyopathy (adjusted HR 2.93; 95% CI 1.89-4.54; P<0.0001).
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