Abstract 14542: High-Sensitivity Troponin T is a Prognostic Marker in Cardiac Sarcoidosis
Background: Cardiac sarcoidosis (CS) is a progressive inflammatory myocardial disease that often leads to left ventricular dysfunction. There are currently no markers of disease activity that would predict the risk of adverse outcome.
Methods: TnT measurements were made for a period of 28 months using the latest generation highly sensitive TnT assay. Over this period, 15 patients were diagnosed with new CS and 38 previously diagnosed patients underwent TnT measurements in association with their follow-up visits. We reviewed their imaging results, treatment data and adverse events.
Results: Patients were followed for 19.7 ± 8.4 months (range, 1-28). Median of 7 (range, 1-15) TnT measurements were taken per patient. Measured TnTs ranged between <5 to 256ng/l (mean, 22.8 ± 56.5). At the time of diagnosis 53% (8/15) had elevated TnT (>14ng/l) and in those patients corticosteroid treatment decreased TnT by at least 50% within one week. During follow-up, 43% (23/53) had elevated TnT. An adverse cardiac event (sudden cardiac death, ventricular fibrillation, ventricular tachycardia, complete heart block, EF reduction >20%, left ventricular assist device implantation) was observed in 9/16 patients (56%) with elevated TnT (>14ng/l) when first measured versus in 10/37 patients (27%) with normal TnT (p=0.01, log-rank). Patients with normal TnTs in all measurements had significantly less adverse events (6/30, 20%) compared to those having elevated TnTs (13/23, 56.5%) (p=0.002, log-rank). Importantly, in patients with normal (>50%) EF at presentation (n=33) in whom prognosis is particularly difficult to predict, elevated TnT either at diagnosis or during follow-up appeared to be associated with increased frequency of adverse cardiac events (follow-up TnT p=0.002).
Conclusions: An elevated TnT is associated with greater risk of adverse events in cardiac sarcoidosis. Corticosteroid treatment rapidly lowers TnT. We think that serial measurements of TnT could be used as a marker of treatment response and prognosis in CS.
- © 2013 by American Heart Association, Inc.