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Prognostic value of high-sensitive troponin T in patients with severe aortic stenosis undergoing valve replacement surgery

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Abstract

Background

Aortic stenosis (AS) is a well-known cause of mortality. We aimed to assess the prognostic value of high-sensitive troponin T (hs-TnT) in symptomatic patients with severe AS and preserved left ventricular ejection fraction (LVEF) after surgical aortic valve replacement (AVR).

Patients and methods

The study recruited patients with severe symptomatic AS fulfilling the inclusion criteria in the period between April 2020 and February 2022. Comprehensive echocardiography was done. The following parameters were assessed: AS severity, LV mass index (LVMI), left atrium volume index (LAVI), and LVEF. E/e′ and LVEF were calculated using the biplane method of Simpsons. Global longitudinal strain (GLS) was assessed by speckle tracking echocardiography. Peripheral blood samples were collected for hs-TnT measurement. All patients underwent surgical AVR. The patients were followed for the following 6 months for major adverse cardiovascular events (MACE). MACE was defined as cardiac death, re-admission for congestive heart failure (CHF) and fatal arrhythmia.

Results

One hundred and eight patients (mean age = 58.7 ± 7.68 years) with severe AS were recruited. Seventeen patients presented with MACE including 8 cardiac deaths. We divided the patients into two groups based on the normal hs-TnT values. The Kaplan–Meier curve revealed a statistically significant difference in MACE rate among troponin groups (log-rank test = 5.06, p = 0.025). There was significant difference between both groups regarding GLS with smaller GLS in negative hs-TnT group. In multivariate analysis, GLS and hs-TnT were significantly associated with MACE (p = 0.022 and < 0.01 respectively). The cutoff value of hs-TnT of 238.25 had a sensitivity of 70% and a specificity of 81% for predicting future MACE. There was a significant correlation between GLS and troponin (p < 0.001).

Conclusions

hs-TnT is associated with bad short-term prognosis after AVR. hs-TnT and GLS could be significant predictors for future MACE in patients with severe symptomatic AS and preserved LVEF who underwent AVR. Elevated hs-TnT and impaired GLS could set an indication of early intervention in asymptomatic severe AS.

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Data availability

The datasets used and/or analyzed during the current study are available from the author (Dr. Mohammad Fikry) upon reasonable request.

Abbreviations

AS:

Aortic stenosis

hs-TnT:

High-sensitive troponin T

LVEF:

Left ventricular ejection fraction

LV:

Left ventricle

MACE:

Major adverse cardiovascular event

AVR:

Aortic valve replacement

CHF:

Congestive heart failure

AVA:

Aortic valve area

BSA:

Body surface area

LVOT:

Left ventricle outflow tract

LVMI:

LV mass index

LAVI:

Left atrial volume index

DFS:

Disease-free survival

MRI:

Magnetic resonance imaging

LGE:

Late gadolinium enhancement

TAVR:

Transcatheter aortic valve replacement

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Authors and Affiliations

  1. Cardiology Department, Zagazig University, Zagazig, Egypt

    Alaa Salama, Ghada Ibrahim, Mohammad Fikry, Moataz Hassan Elsannan & Mohammad Eltahlawi

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  1. Alaa Salama
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  2. Ghada Ibrahim
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  3. Mohammad Fikry
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  4. Moataz Hassan Elsannan
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  5. Mohammad Eltahlawi
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Contributions

AS analyzed and interpreted the patient data. GI was responsible for conceptualization and validation. MF was responsible for formal analysis, conducting research, collection of data, and investigation process. MHE was responsible for revision, validation, and data curation. ME was responsible for conceptualization of concept and writing the draft. All authors have read and approved the manuscript.

Corresponding author

Correspondence to Mohammad Eltahlawi.

Ethics declarations

Ethics Committee approval

Ethical approval was granted from the ethical committee of the Faculty of Medicine, Zagazig University vide reference No. 6334 dated 23-08-2020.

Consent to participate

Informed consent was obtained from each participant.

Human and Animal Rights Statement

The study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki. Confidentiality of participants’ personal information was maintained throughout the research process, and all data were anonymized to protect their identities. This research did not involve the use of animals. Therefore, no animals were harmed or subjected to experimentation for the purpose of this study.

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The authors declare that they have no competing interests.

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Salama, A., Ibrahim, G., Fikry, M. et al. Prognostic value of high-sensitive troponin T in patients with severe aortic stenosis undergoing valve replacement surgery. Indian J Thorac Cardiovasc Surg 40, 142–150 (2024). https://doi.org/10.1007/s12055-023-01594-5

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