Prognostic value of high-sensitivity cardiac troponin T in patients with endomyocardial-biopsy proven cardiac amyloidosis

Objective To investigate prognostic predictors of long-term survival of patients with cardiac amyloidosis(CA),and to determine predictive value of high-sensitivity cardiac troponin T(hs-cTnT) in CA patients.Methods We recruited 102 consecutive CA cases and followed these patients for 5 years.We described their clinical characteristics at presentation and used a new,high-sensitivity assay to determine the concentration of cTnT in plasma samples from these patients.Results The patients with poor prognosis showed older age(56 ± 12 years vs.50 ± 15 years,P = 0.022),higher incidences of heart failure(36.92%vs.16.22%,P = 0.041),pericardial effusion(60.00%vs.35.14%,P = 0.023),greater thickness of interventricular septum(IVS)(15 ± 4 mm vs.13 ± 4 mm,P = 0.034),higher level of hs-cTnT(0.186 ± 0.249 ng/mL vs.0.044 ± 0.055 ng/mL,P = 0.001) and higher NT-proBNP(N-terminal pro-B-type natriuretic peptide) levels(11,742 ± 10,464 pg/mL vs.6,031 ± 7,458 pg/mL,P = 0.006).At multivariate Cox regression analysis,heart failure(HR:1.78,95%CI:1.09-2.92,P = 0.021),greater wall thickness of IVS(HR:1.44,95%CI:1.04-3.01,P = 0.0375) and higher hs-cTnT level(HR:6.16,95%CI:2.20-17.24,P = 0.001) at enrollment emerged as independent predictors of all-cause mortality.Conclusions We showed that hs-cTnT is associated with a very ominous prognosis,and it is also the strongest predictor of all-cause mortality in multivariate analysis.Examination of hs-cTnT concentrations provides valuable prognostic information concerning long-term outcomes.