Clinical and echocardiographic correlates of elevated troponin in amyloid light-chain cardiac amyloidosis

Teimuraz Apridonidze, Richard M. Steingart, Raymond L. Comenzo, James E Hoffman, Yuliya Goldsmith, Jonathan N. Bella, Heather Landau, Jennifer E. Liu

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Increased troponin is associated with poor survival in patients with amyloid light-chain (AL) amyloidosis with cardiac involvement (CAL). The purpose of this investigation was to define the relation between increased troponin and clinical, morphologic, and functional features. The comparative utility of clinical, echocardiographic, and biochemical measurements in predicting survival in CAL was also investigated. One hundred seventeen patients with CAL were divided into 2 groups: normal troponin I (<0.06 ng/ml, n = 42) or increased troponin I (<0.06 ng/ml, n = 75). Patients in the high troponin I group were older (63 vs 58 years, p = 0.04), with higher B-type natriuretic peptide levels (1,417 vs 936 pg/ml, p = 0.0004). The high troponin I group also had higher echocardiography-determined early/late mitral inflow velocity ratio (2.2 vs 1.4, p = 0.005) and myocardial performance index (0.59 vs 0.45, p = 0.04) and lower stroke index (28 vs 38 ml/beat/m2, p <0.0001) and left atrial systolic force (5.9 vs 8.4 k-dynes, p = 0.037) than the normal troponin group. Median survival was significantly shorter in the high troponin group (11 vs 45 months, p <0.001). At time of CAL diagnosis, univariate predictors of all-cause mortality included increased troponin, older age, male gender, New York Heart Association class III to IV, >2 organs involved, higher B-type natriuretic peptide, lower creatinine clearance, greater ventricular septal thickness, and higher myocardial performance index. However, by multivariate Cox survival analysis, only increased troponin was a significant predictor for all-cause mortality (hazard ratio 3.1, p = 0.002). In conclusion, increased troponin is associated with worse left ventricular and left atrial functions by echocardiography in patients with CAL. Among baseline variables, it is the strongest predictor of all-cause mortality in multivariate analysis. Troponin is a powerful tool in clinical and prognostic assessments of patients with CAL.

Original languageEnglish (US)
Pages (from-to)1180-1184
Number of pages5
JournalAmerican Journal of Cardiology
Volume110
Issue number8
DOIs
StatePublished - Oct 15 2012
Externally publishedYes

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Troponin
Amyloidosis
Amyloid
Light
Left Atrial Function
Troponin I
Survival
Mortality
Brain Natriuretic Peptide
Survival Analysis
Echocardiography
Creatinine
Multivariate Analysis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Clinical and echocardiographic correlates of elevated troponin in amyloid light-chain cardiac amyloidosis. / Apridonidze, Teimuraz; Steingart, Richard M.; Comenzo, Raymond L.; Hoffman, James E; Goldsmith, Yuliya; Bella, Jonathan N.; Landau, Heather; Liu, Jennifer E.

In: American Journal of Cardiology, Vol. 110, No. 8, 15.10.2012, p. 1180-1184.

Research output: Contribution to journalArticle

Apridonidze, T, Steingart, RM, Comenzo, RL, Hoffman, JE, Goldsmith, Y, Bella, JN, Landau, H & Liu, JE 2012, 'Clinical and echocardiographic correlates of elevated troponin in amyloid light-chain cardiac amyloidosis', American Journal of Cardiology, vol. 110, no. 8, pp. 1180-1184. https://doi.org/10.1016/j.amjcard.2012.05.061
Apridonidze, Teimuraz ; Steingart, Richard M. ; Comenzo, Raymond L. ; Hoffman, James E ; Goldsmith, Yuliya ; Bella, Jonathan N. ; Landau, Heather ; Liu, Jennifer E. / Clinical and echocardiographic correlates of elevated troponin in amyloid light-chain cardiac amyloidosis. In: American Journal of Cardiology. 2012 ; Vol. 110, No. 8. pp. 1180-1184.
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