What is the clinical evidence from this study?

Study design: Cohort. Population: Hypertrophic Obstructive Cardiomyopathy (n=163). Intervention: Serum cardiac troponin I (cTnI) and NT-proBNP. Primary outcome: Presence of late gadolinium enhancement (LGE) (OR 3.193, 95% CI 1.099-9.281, p=0.033).

What does this research mean for the field?

Serum cardiac troponin I and maximum wall thickness independently predict the presence of myocardial fibrosis in patients with hypertrophic obstructive cardiomyopathy, and their combined measurement provides high diagnostic performance. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

January 14, 2016Open Access

Predictive Values of N-Terminal Pro-B-Type Natriuretic Peptide and Cardiac Troponin I for Myocardial Fibrosis in Hypertrophic Obstructive Cardiomyopathy

CZChanglin ZhangKunming Medical University RLRong LiuYunnan University JYJiansong YuanInterventional Cardiology

Key Result

Serum cardiac troponin I (OR 3.193) and maximum wall thickness (OR 1.410) independently predicted the presence of myocardial fibrosis in patients with hypertrophic obstructive cardiomyopathy.

Study Design

Type

Cohort (n=163)

Multicenter

Structured PICO

Does measurement of NT-proBNP and cTnI predict myocardial fibrosis in patients with hypertrophic obstructive cardiomyopathy?

Population

163 patients with hypertrophic obstructive cardiomyopathy (HOCM), mean age 47.2 ± 10.8 years, 61.3% men, from a single center in China. Key exclusions: established coronary artery disease, valvular heart disease, LVEF <50%, renal dysfunction (eGFR <60 ml/min/1.73 m2).

Intervention

Measurement of peripheral concentrations of N-Terminal Pro-B-Type Natriuretic Peptide (NT-proBNP) and cardiac troponin I (cTnI)

Outcome

Presence and extent of myocardial fibrosis as determined by late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR)surrogate

Main Result

Effect estimate: OR 3.193 (95% CI 1.099-9.281)

p-value: p=0.033

Limitations

Retrospective design
Single-center study

Abstract

BACKGROUND: Both high-sensitivity cardiac troponin T and B-type natriuretic peptide are useful in detecting myocardial fibrosis, as determined by late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR), in patients with non-obstructive hypertrophic cardiomyopathy. However, their values to predict myocardial fibrosis in hypertrophic obstructive cardiomyopathy (HOCM) remain unclear. We investigated the role of N-Terminal Pro-B-Type Natriuretic Peptide (NT-proBNP) and cardiac troponin I (cTnI) to identify LGE-CMR in patients with HOCM. METHODS: Peripheral concentrations of NT-proBNP and cTnI were determined in patients with HOCM (n = 163; age = 47.2 ± 10.8 years; 38.7% females). Contrast-enhanced CMR was performed to identify and quantify myocardial fibrosis. RESULTS: LGE was detected in 120 of 163 patients (73.6%). Patients with LGE had significantly higher levels of NT-proBNP and cTnI than those without LGE (1386.2 904.6-2340.8 vs. 866.6 707.2-1875.2 pmol/L, P = 0.003; 0.024 0.010-0.049 vs. 0.010 0.005-0.021 ng/ml, P <0.001, respectively). The extent of LGE was positively correlated with log cTnI (r = 0.371, P <0.001) and log NT-proBNP (r = 0.211, P = 0.007). On multivariable analysis, both log cTnI and maximum wall thickness (MWT) were independent predictors of the presence of LGE (OR = 3.193, P = 0.033; OR = 1.410, P < 0.001, respectively), whereas log NT-proBNP was not. According to the ROC curve analysis, combined measurements of MWT ≥21 mm and/or cTnI ≥0.025 ng/ml indicated good diagnostic performance for the presence of LGE, with specificity of 95% or sensitivity of 88%. CONCLUSIONS: Serum cTnI is an independent predictor useful for identifying myocardial fibrosis, while plasma NT-proBNP is only associated with myocardial fibrosis on univariate analysis. Combined measurements of serum cTnI with MWT further improve its value in detecting myocardial fibrosis in patients with HOCM.

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