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.