Usefulness of High-Sensitivity Cardiac Troponin T to Predict Long-Term Outcome in Patients with Hypertrophic Cardiomyopathy

Abstract

Since the first report of an association between cardiac troponin (cTn) and adverse outcome in hypertrophic cardiomyopathy (HD), there is a paucity in confirmative data. We performed a prospective, prespecified 5-year follow-up cohort study of 135 HC patients who participated in a national multicenter project and underwent clinical evaluation, MRI (cine, LGE and T2-weighted imaging) and biomarker assessment (high-sensitivity cTnT (hs-cTnT), N-terminal pro-B-type natriuretic peptide, soluble tumorgenicity suppressor-2, Galectin-3, Growth differentiation factor-15, C-terminal Propeptide of Type I Collagen (CICP)). An elevated hs-cTnT concentration was defined as ≥14ng/L. Follow-up was systematically performed for the primary endpoint: a composite of sudden cardiac death, heart failure related death, stroke-related death, heart failure hospitalization, hospitalization for stroke, spontaneous sustained ventricular tachycardia (VT) or appropriate ICD discharge, and progression to NYHA class III-IV. Elevated hs-cTnT was present in 33 of 135 (24%) HC patients. During a median follow-up of 5.0 years (IQR: 4.9-5.1) 18 patients reached the primary endpoint. Using Cox regression analysis, elevated hs-cTnT was univariately associated with the primary endpoint (HR: 3.4 (95%CI: 1.4-8.7, p=0.009). Also female sex, previous syncope, previous non-sustained VT, reduced LV ejection fraction (<50%) and CICP were associated with the primary endpoint. In multivariable analysis, elevated hs-cTnT remained independently associated with outcome (aHR: 4.7 (95%CI: 1.8-12.6, p = 0.002). In conclusion, this 5-year follow-up study is the first to prospectively confirm the association of elevated hs-cTnT and adverse outcomes. In addition to established clinical variables, cTn seems the biomarker of interest to further improve risk prediction in HC, which should be evaluated in larger prospective registries. Since the first report of an association between cardiac troponin (cTn) and adverse outcome in hypertrophic cardiomyopathy (HD), there is a paucity in confirmative data. We performed a prospective, prespecified 5-year follow-up cohort study of 135 HC patients who participated in a national multicenter project and underwent clinical evaluation, MRI (cine, LGE and T2-weighted imaging) and biomarker assessment (high-sensitivity cTnT (hs-cTnT), N-terminal pro-B-type natriuretic peptide, soluble tumorgenicity suppressor-2, Galectin-3, Growth differentiation factor-15, C-terminal Propeptide of Type I Collagen (CICP)). An elevated hs-cTnT concentration was defined as ≥14ng/L. Follow-up was systematically performed for the primary endpoint: a composite of sudden cardiac death, heart failure related death, stroke-related death, heart failure hospitalization, hospitalization for stroke, spontaneous sustained ventricular tachycardia (VT) or appropriate ICD discharge, and progression to NYHA class III-IV. Elevated hs-cTnT was present in 33 of 135 (24%) HC patients. During a median follow-up of 5.0 years (IQR: 4.9-5.1) 18 patients reached the primary endpoint. Using Cox regression analysis, elevated hs-cTnT was univariately associated with the primary endpoint (HR: 3.4 (95%CI: 1.4-8.7, p=0.009). Also female sex, previous syncope, previous non-sustained VT, reduced LV ejection fraction (<50%) and CICP were associated with the primary endpoint. In multivariable analysis, elevated hs-cTnT remained independently associated with outcome (aHR: 4.7 (95%CI: 1.8-12.6, p = 0.002). In conclusion, this 5-year follow-up study is the first to prospectively confirm the association of elevated hs-cTnT and adverse outcomes. In addition to established clinical variables, cTn seems the biomarker of interest to further improve risk prediction in HC, which should be evaluated in larger prospective registries. Hypertrophic cardiomyopathy (HC) is clinically characterized by a very heterogeneous disease presentation ranging from asymptomatic patients with sudden cardiac death (SCD) to progressive heart failure (HF).1Elliott PM Anastasakis A Borger MA Borggrefe M Cecchi F Charron P Hagege AA Lafont A Limongelli G Mahrholdt H McKenna WJ Mogensen J Nihoyannopoulos P Nistri S Pieper PG Pieske B Rapezzi C Rutten FH Tillmanns C Watkins H 2014 ESC Guidelines on diagnosis and management of hypertrophic cardiomyopathy: The Task Force for the Diagnosis and Management of Hypertrophic Cardiomyopathy of the European Society of Cardiology (ESC).Eur Heart J. 2014; 35: 2733-2779Crossref PubMed Scopus (27) Google Scholar,2Gersh BJ Maron BJ Bonow RO Dearani JA Fifer MA Link MS Naidu SS Nishimura RA Ommen SR Rakowski H Seidman CE Towbin JA Udelson JE Yancy CW. 2011 ACCF/AHA guideline for the diagnosis and treatment of hypertrophic cardiomyopathy: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines.Circulation. 2011; 124: e783-e831Crossref PubMed Scopus (630) Google Scholar Despite ongoing initiatives to improve risk stratification for SCD, there is limited information on how to discriminate between low and high risk HC patients with regard to the broader spectrum of clinical endpoints.3Kramer CM Appelbaum E Desai MY Desvigne-Nickens P DiMarco JP Friedrich MG Geller N Heckler S Ho CY Jerosch-Herold M Ivey EA Keleti J Kim DY Kolm P Kwong RY Maron MS Schulz-Menger J Piechnik S Watkins H Weintraub WS Wu P Neubauer S. Hypertrophic Cardiomyopathy Registry: the rationale and design of an international, observational study of hypertrophic cardiomyopathy.Am Heart J. 2015; 170: 223-230Crossref PubMed Scopus (88) Google Scholar Ischemia as a result of imbalance between increased myocardial oxygen demand in the presence of hypertrophy, and reduced myocardial oxygen supply due to microvascular disease importantly contributes to the clinical presentation of HC.1Elliott PM Anastasakis A Borger MA Borggrefe M Cecchi F Charron P Hagege AA Lafont A Limongelli G Mahrholdt H McKenna WJ Mogensen J Nihoyannopoulos P Nistri S Pieper PG Pieske B Rapezzi C Rutten FH Tillmanns C Watkins H 2014 ESC Guidelines on diagnosis and management of hypertrophic cardiomyopathy: The Task Force for the Diagnosis and Management of Hypertrophic Cardiomyopathy of the European Society of Cardiology (ESC).Eur Heart J. 2014; 35: 2733-2779Crossref PubMed Scopus (27) Google Scholar,2Gersh BJ Maron BJ Bonow RO Dearani JA Fifer MA Link MS Naidu SS Nishimura RA Ommen SR Rakowski H Seidman CE Towbin JA Udelson JE Yancy CW. 2011 ACCF/AHA guideline for the diagnosis and treatment of hypertrophic cardiomyopathy: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines.Circulation. 2011; 124: e783-e831Crossref PubMed Scopus (630) Google Scholar In that regard, it is surprising that the role of cardiac troponin (cTn) in HC patients has not been extensively studied.4Gommans DF Cramer GE Bakker J Michels M Dieker HJ Timmermans J Fouraux MA Marcelis CL Verheugt FW Brouwer MA Kofflard MJ. High T2-weighted signal intensity is associated with elevated troponin T in hypertrophic cardiomyopathy.Heart. 2017; 103: 293-299Crossref PubMed Scopus (13) Google Scholar, 5Gommans DF Cramer GE Fouraux MA Bakker J Michels M Dieker HJ Timmermans J Marcelis C Verheugt FWA De Boer M-J Kofflard MJM De Boer RA Brouwer MA. Prediction of extensive fibrosis in Hypertrophic Cardiomyopathy.Am J Cardiol. 2018; 122: 483-489Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar, 6Kubo T Kitaoka H Yamanaka S Hirota T Baba Y Hayashi K Iiyama T Kumagai N Tanioka K Yamasaki N Matsumura Y Furuno T Sugiura T Doi YL. Significance of High-Sensitivity Cardiac Troponin T in Hypertrophic Cardiomyopathy.J Am Coll Cardiol. 2013; 62: 1252-1259Crossref PubMed Scopus (85) Google Scholar, 7Cramer G Bakker J Gommans F Brouwer M Kurvers M Fouraux M Verheugt F Kofflard M. Relation of highly sensitive cardiac troponin T in hypertrophic cardiomyopathy to left ventricular mass and cardiovascular risk.Am J Cardiol. 2014; 113: 1240-1245Abstract Full Text Full Text PDF PubMed Scopus (25) Google Scholar Elevated cTn is a common finding and associated with adverse disease characteristics, such as wall thickness and late gadolinium enhancement (LGE).4Gommans DF Cramer GE Bakker J Michels M Dieker HJ Timmermans J Fouraux MA Marcelis CL Verheugt FW Brouwer MA Kofflard MJ. High T2-weighted signal intensity is associated with elevated troponin T in hypertrophic cardiomyopathy.Heart. 2017; 103: 293-299Crossref PubMed Scopus (13) Google Scholar, 5Gommans DF Cramer GE Fouraux MA Bakker J Michels M Dieker HJ Timmermans J Marcelis C Verheugt FWA De Boer M-J Kofflard MJM De Boer RA Brouwer MA. Prediction of extensive fibrosis in Hypertrophic Cardiomyopathy.Am J Cardiol. 2018; 122: 483-489Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar, 6Kubo T Kitaoka H Yamanaka S Hirota T Baba Y Hayashi K Iiyama T Kumagai N Tanioka K Yamasaki N Matsumura Y Furuno T Sugiura T Doi YL. Significance of High-Sensitivity Cardiac Troponin T in Hypertrophic Cardiomyopathy.J Am Coll Cardiol. 2013; 62: 1252-1259Crossref PubMed Scopus (85) Google Scholar, 7Cramer G Bakker J Gommans F Brouwer M Kurvers M Fouraux M Verheugt F Kofflard M. Relation of highly sensitive cardiac troponin T in hypertrophic cardiomyopathy to left ventricular mass and cardiovascular risk.Am J Cardiol. 2014; 113: 1240-1245Abstract Full Text Full Text PDF PubMed Scopus (25) Google Scholar, 8Sato Y Taniguchi R Nagai K Makiyama T Okada H Yamada T Matsumori A Takatsu Y. Measurements of cardiac troponin T in patients with hypertrophic cardiomyopathy.Heart. 2003; 89: 659-660Crossref PubMed Scopus (44) Google Scholar In 2013, the first report was published that demonstrated an association between elevated cTnT, assessed with a high-sensitivity assay (hs-cTnT) and adverse long-term outcome in HC.6Kubo T Kitaoka H Yamanaka S Hirota T Baba Y Hayashi K Iiyama T Kumagai N Tanioka K Yamasaki N Matsumura Y Furuno T Sugiura T Doi YL. Significance of High-Sensitivity Cardiac Troponin T in Hypertrophic Cardiomyopathy.J Am Coll Cardiol. 2013; 62: 1252-1259Crossref PubMed Scopus (85) Google Scholar Ever since, however, there is a paucity of confirmatory prospective data.3Kramer CM Appelbaum E Desai MY Desvigne-Nickens P DiMarco JP Friedrich MG Geller N Heckler S Ho CY Jerosch-Herold M Ivey EA Keleti J Kim DY Kolm P Kwong RY Maron MS Schulz-Menger J Piechnik S Watkins H Weintraub WS Wu P Neubauer S. Hypertrophic Cardiomyopathy Registry: the rationale and design of an international, observational study of hypertrophic cardiomyopathy.Am Heart J. 2015; 170: 223-230Crossref PubMed Scopus (88) Google Scholar,8Sato Y Taniguchi R Nagai K Makiyama T Okada H Yamada T Matsumori A Takatsu Y. Measurements of cardiac troponin T in patients with hypertrophic cardiomyopathy.Heart. 2003; 89: 659-660Crossref PubMed Scopus (44) Google Scholar, 9Hasler S Manka R Greutmann M Gamperli O Schmied C Tanner FC Biaggi P Luscher TF Keller DI Gruner C. Elevated high-sensitivity troponin T levels are associated with adverse cardiac remodelling and myocardial fibrosis in hypertrophic cardiomyopathy.Swiss Med Wkly. 2016; 146: w14285PubMed Google Scholar, 10Nakamura S Takano H Matsuda J Chinen D Kitamura M Murai K Asai K Yasutake M Takayama M Shimizu W. Prognostic values of highly sensitive cardiac troponin T and B-type natriuretic peptide for clinical features in hypertrophic obstructive cardiomyopathy: a cross-sectional study.BMJ Open. 2014; 4e005968Crossref PubMed Scopus (14) Google Scholar Therefore, we aimed to validate the association between elevated hs-cTnT and adverse outcomes in a prospective HC cohort with 5 years of clinical follow-up. From a Dutch HC multicenter study on biomarkers, MRI and exercise, we selected HC patients of whom baseline hs-cTnT concentration was available.11Cramer GE Gommans DHF Dieker HJ Michels M Verheugt F de Boer MJ Bakker J Fouraux MA Timmermans J Kofflard M Brouwer M. Exercise and myocardial injury in hypertrophic cardiomyopathy.Heart. 2020; 106: 1169-1175Crossref PubMed Scopus (7) Google Scholar In short, adult HC patients from different hospitals were enrolled at 2 outpatient clinics (Radboud University Medical Center, Nijmegen and Albert Schweitzer Hospital, Dordrecht, The Netherlands) between 2008 and 2014. Patients had to fulfill the diagnostic criteria for HC according to the prevailing guidelines and had no history of coronary artery disease or septal reduction therapy. The study complies with the Declaration of Helsinki. The protocol was approved by local ethical committees and conducted accordingly. All participants provided written informed consent. Blood samples were processed within 60 minutes after phlebotomy, and stored at –80°C until analysis. Serum samples were used for hs-cTnT. An elevated hs-cTnT concentration was defined as a concentration ≥14ng/L. Our biomarker panel also included: N-terminal-pro-B-type-Natriuretic Peptide, Galectin-3, soluble Tumorigenicity Suppressor2, Growth Differentation Factor-15 and C-terminal Propeptide of Type I Collagen (CICP (Appendix for detailed description of the assays).5Gommans DF Cramer GE Fouraux MA Bakker J Michels M Dieker HJ Timmermans J Marcelis C Verheugt FWA De Boer M-J Kofflard MJM De Boer RA Brouwer MA. Prediction of extensive fibrosis in Hypertrophic Cardiomyopathy.Am J Cardiol. 2018; 122: 483-489Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar Variability and performance in healthy controls and patients with heart failure have been published.12Meijers WC van der Velde AR Muller Kobold AC Dijck-Brouwer J Wu AH Jaffe A de Boer RA Variability of biomarkers in patients with chronic heart failure and healthy controls.Eur J Heart Fail. 2017; 19: 357-365Crossref PubMed Scopus (78) Google Scholar CMR imaging with cine, LGE and T2-weighted sequences was performed on 1.5T CMR systems (Philips Achieva (Philips Healthcare, Best, The Netherlands) or (Siemens Avanto (Siemens Health Care, Erlangen, Germany)) according to local imaging protocols, as previously described.4Gommans DF Cramer GE Bakker J Michels M Dieker HJ Timmermans J Fouraux MA Marcelis CL Verheugt FW Brouwer MA Kofflard MJ. High T2-weighted signal intensity is associated with elevated troponin T in hypertrophic cardiomyopathy.Heart. 2017; 103: 293-299Crossref PubMed Scopus (13) Google Scholar Images were analyzed with commercially available software (QMass 7.5, Medis, Leiden, The Netherlands) by three observers unaware of the subjects’ clinical information. The extent of LGE was scored visually according to a semi-quantitative score.4Gommans DF Cramer GE Bakker J Michels M Dieker HJ Timmermans J Fouraux MA Marcelis CL Verheugt FW Brouwer MA Kofflard MJ. High T2-weighted signal intensity is associated with elevated troponin T in hypertrophic cardiomyopathy.Heart. 2017; 103: 293-299Crossref PubMed Scopus (13) Google Scholar Our primary endpoint was a composite of SCD, HF–related death, stroke-related death, HF hospitalization, hospitalization for stroke, spontaneous sustained ventricular tachycardia (VT) or appropriate implantable cardioverter-defibrillator (ICD) discharge, and progression to New York Heart Association (NYHA) functional class III or IV status.6Kubo T Kitaoka H Yamanaka S Hirota T Baba Y Hayashi K Iiyama T Kumagai N Tanioka K Yamasaki N Matsumura Y Furuno T Sugiura T Doi YL. Significance of High-Sensitivity Cardiac Troponin T in Hypertrophic Cardiomyopathy.J Am Coll Cardiol. 2013; 62: 1252-1259Crossref PubMed Scopus (85) Google Scholar As a secondary aim of the previously mentioned multicenter project, prespecified clinical follow-up was systematically performed with telephone follow-up at two and five years. In case the patient reported a potential endpoint, the patients’ medical file was reviewed for event adjudication, which was performed by two investigators based on consensus (FG and EC); in case of non-consensus a third investigator provided final adjudication (MK). Continuous variables are presented as means (± or and were between patients with and elevated hs-cTnT a or variables were a or As primary analysis, and Cox regression were performed for the association between elevated hs-cTnT and the first of the primary endpoint. In were performed for hs-cTnT as a associated with the primary endpoint in were selected for A of was was performed with the analysis, the study 135 HC in no hs-cTnT concentration was are to with = or elevated cTnT = in follow-up was 5.0 years (IQR: 4.9-5.1) with During follow-up 18 patients the primary endpoint: death = stroke-related death = HF hospitalization = hospitalization for = spontaneous sustained or appropriate ICD = and progression to NYHA functional class III or IV = = = = at at diagnosis heart risk of cardiac history of of non-sustained wall thickness class at wall thickness mass to ejection extent of LV T2-weighted signal are presented as means or = cardiac troponin T assessed with a high-sensitivity = Blood LGE = gadolinium LV = = LV mass to NYHA = New York Heart = cardiac in a are presented as means or = cardiac troponin T assessed with a high-sensitivity = Blood LGE = gadolinium LV = = LV mass to NYHA = New York Heart = cardiac In analysis, patients with an elevated hs-cTnT concentration had a and risk of the primary endpoint 3.4 (95%CI: 1.4-8.7, p = were female sex, previous syncope, previous non-sustained on a reduced left ventricular ejection fraction on and CICP In analysis, elevated hs-cTnT remained independently associated with the primary with non-sustained on and as a was associated with the primary endpoint in (HR: p = in the association was no = and female and non-sustained on were independently associated with outcome (95%CI: p = and (95%CI: p = In an to the 5 risk for in HC, hs-cTnT remained associated with the primary endpoint (95%CI: p = regression for elevated hs-cTnT and the primary hs-cTnT are presented as means or sex, previous syncope, a reduced left ventricular ejection fraction on and CICP concentration were univariately and not independently associated with the primary endpoint. = cardiac troponin T assessed with a high-sensitivity = ventricular in a are presented as means or sex, previous syncope, a reduced left ventricular ejection fraction on and CICP concentration were univariately and not independently associated with the primary endpoint. = cardiac troponin T assessed with a high-sensitivity = ventricular The present 5-year follow-up study on a of participants in a multicenter HC is the first to the association of an elevated hs-cTnT concentration with adverse clinical outcome in demonstrated this association for the first in T Kitaoka H Yamanaka S Hirota T Baba Y Hayashi K Iiyama T Kumagai N Tanioka K Yamasaki N Matsumura Y Furuno T Sugiura T Doi YL. Significance of High-Sensitivity Cardiac Troponin T in Hypertrophic Cardiomyopathy.J Am Coll Cardiol. 2013; 62: 1252-1259Crossref PubMed Scopus (85) Google Scholar and the for follow-up on cTn in larger prospective HC to the potential for of risk prediction also for prediction of and CM Appelbaum E Desai MY Desvigne-Nickens P DiMarco JP Friedrich MG Geller N Heckler S Ho CY Jerosch-Herold M Ivey EA Keleti J Kim DY Kolm P Kwong RY Maron MS Schulz-Menger J Piechnik S Watkins H Weintraub WS Wu P Neubauer S. Hypertrophic Cardiomyopathy Registry: the rationale and design of an international, observational study of hypertrophic cardiomyopathy.Am Heart J. 2015; 170: 223-230Crossref PubMed Scopus (88) Google Scholar risk prediction has on SCD, which is the adverse event for HC patients and risk prediction and the of the ICD clinical on how to risk stratification it has that HC patients from and related to HF and stroke, for which no risk prediction is BJ Maron hypertrophic cardiomyopathy a disease with low by years of clinical and 2016; PubMed Scopus Google BJ Maron 60 Hypertrophic Cardiomyopathy is as a and is this in the J Cardiol. 2020; Full Text Full Text PDF PubMed Scopus Google Scholar The of risk prediction in HC have been the clinical risk based on history and to improve risk stratification are CMR imaging such as and T2-weighted also available and biomarkers be CM Appelbaum E Desai MY Desvigne-Nickens P DiMarco JP Friedrich MG Geller N Heckler S Ho CY Jerosch-Herold M Ivey EA Keleti J Kim DY Kolm P Kwong RY Maron MS Schulz-Menger J Piechnik S Watkins H Weintraub WS Wu P Neubauer S. Hypertrophic Cardiomyopathy Registry: the rationale and design of an international, observational study of hypertrophic cardiomyopathy.Am Heart J. 2015; 170: 223-230Crossref PubMed Scopus (88) Google DF Cramer GE Bakker J Michels M Dieker HJ Timmermans J Fouraux MA Marcelis CL Verheugt FW Brouwer MA Kofflard MJ. High T2-weighted signal intensity is associated with elevated troponin T in hypertrophic cardiomyopathy.Heart. 2017; 103: 293-299Crossref PubMed Scopus (13) Google GE Gommans DHF Dieker HJ Michels M Verheugt F de Boer MJ Bakker J Fouraux MA Timmermans J Kofflard M Brouwer M. Exercise and myocardial injury in hypertrophic cardiomyopathy.Heart. 2020; 106: 1169-1175Crossref PubMed Scopus (7) Google Scholar In this we confirm the association of an elevated hs-cTnT with long-term adverse outcome in T Kitaoka H Yamanaka S Hirota T Baba Y Hayashi K Iiyama T Kumagai N Tanioka K Yamasaki N Matsumura Y Furuno T Sugiura T Doi YL. Significance of High-Sensitivity Cardiac Troponin T in Hypertrophic Cardiomyopathy.J Am Coll Cardiol. 2013; 62: 1252-1259Crossref PubMed Scopus (85) Google Scholar and the of was related to HF to ventricular hs-cTnT as a we also demonstrated a association with clinical outcome in analysis, in was no present = which be related to limited cohort and event the with hs-cTnT to the 5 risk used in cohort and event we used a composite of and HF to T Kitaoka H Yamanaka S Hirota T Baba Y Hayashi K Iiyama T Kumagai N Tanioka K Yamasaki N Matsumura Y Furuno T Sugiura T Doi YL. Significance of High-Sensitivity Cardiac Troponin T in Hypertrophic Cardiomyopathy.J Am Coll Cardiol. 2013; 62: 1252-1259Crossref PubMed Scopus (85) Google Scholar The of in study is in with previous which is also for ventricular in T Kitaoka H Yamanaka S Hirota T Baba Y Hayashi K Iiyama T Kumagai N Tanioka K Yamasaki N Matsumura Y Furuno T Sugiura T Doi YL. Significance of High-Sensitivity Cardiac Troponin T in Hypertrophic Cardiomyopathy.J Am Coll Cardiol. 2013; 62: 1252-1259Crossref PubMed Scopus (85) Google S Manka R Greutmann M Gamperli O Schmied C Tanner FC Biaggi P Luscher TF Keller DI Gruner C. Elevated high-sensitivity troponin T levels are associated with adverse cardiac remodelling and myocardial fibrosis in hypertrophic cardiomyopathy.Swiss Med Wkly. 2016; 146: w14285PubMed Google S Takano H Matsuda J Chinen D Kitamura M Murai K Asai K Yasutake M Takayama M Shimizu W. Prognostic values of highly sensitive cardiac troponin T and B-type natriuretic peptide for clinical features in hypertrophic obstructive cardiomyopathy: a cross-sectional study.BMJ Open. 2014; 4e005968Crossref PubMed Scopus (14) Google Scholar Our cohort was at low risk 5-year risk was with ventricular in of patients. reported this in of T Kitaoka H Yamanaka S Hirota T Baba Y Hayashi K Iiyama T Kumagai N Tanioka K Yamasaki N Matsumura Y Furuno T Sugiura T Doi YL. Significance of High-Sensitivity Cardiac Troponin T in Hypertrophic Cardiomyopathy.J Am Coll Cardiol. 2013; 62: 1252-1259Crossref PubMed Scopus (85) Google Scholar to that we not a association between hs-cTnT and ventricular as outcome from it also be that cTn HF outcomes which has previously been demonstrated for the as de JA WJ M Association of of cardiac troponin T a sensitive assay with heart failure and cardiovascular in PubMed Scopus Google Scholar the for prospective on cTn in HC long-term follow-up. In of the the of the HC by are highly CM Appelbaum E Desai MY Desvigne-Nickens P DiMarco JP Friedrich MG Geller N Heckler S Ho CY Jerosch-Herold M Ivey EA Keleti J Kim DY Kolm P Kwong RY Maron MS Schulz-Menger J Piechnik S Watkins H Weintraub WS Wu P Neubauer S. Hypertrophic Cardiomyopathy Registry: the rationale and design of an international, observational study of hypertrophic cardiomyopathy.Am Heart J. 2015; 170: 223-230Crossref PubMed Scopus (88) Google Scholar cohort study be the available to the role of clinical characteristics, biomarkers as as CMR imaging variables in the prediction of and HF the clinical variables, confirm with outcome for syncope, non-sustained on as as female and reduced left ventricular on the variables such as LV and left were not associated with outcome in As the primary of project was on biomarkers, MRI and exercise, of was protocol and was GE Gommans DHF Dieker HJ Michels M Verheugt F de Boer MJ Bakker J Fouraux MA Timmermans J Kofflard M Brouwer M. Exercise and myocardial injury in hypertrophic cardiomyopathy.Heart. 2020; 106: 1169-1175Crossref PubMed Scopus (7) Google Scholar We that on be for event In that regard, in it be to a to the potential of As we biomarkers and CMR imaging variables, were independently of We to that the of an association between variables LGE in and outcome be an of of The limited event are an to at the of study design the CMR were not An be that cTn and CMR imaging have different LGE and CMR imaging be for SCD, cTn be of the risk of HF cTn larger are to study the in the prediction of adverse and HF in In conclusion, after 5 years after the on the of cTn in patients with HC, we the first that cTn is associated with adverse outcome in patients. As a biomarker of cTn as a to such as analysis, analysis, analysis, analysis, analysis, and de analysis, The that have no or that have to the reported in this with

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