High sensitivity cardiac troponin T in patients with immunoglobulin light chain amyloidosis

Dispenzieri, A.; Gertz, M. A.; Kumar, S. K.; Lacy, M. Q.; Kyle, R. A.; Saenger, A. K.; Grogan, M.; Zeldenrust, S. R.; Hayman, S. R.; Buadi, F.; Greipp, P. R.; Leung, N.; Russell, S. R.; Dingli, D.; Lust, J. A.; Rajkumar, S. V.; Jaffe, A. S.
March 2014
Heart;Mar2014, Vol. 100 Issue 5, p383
Academic Journal
Objectives: To define whether the high sensitivity cardiac troponin T (hs-cTnT) assay in patients with immunoglobulin light chain amyloidosis (AL) improves risk prediction. Background: Cardiac involvement is the major cause of death in patients with AL amyloidosis. Risk stratification is facilitated by cardiac biomarkers such as cardiac troponin T (cTnT) and N-terminal pro B-type natriuretic peptide (NT-proBNP). Methods: Stored serum from patients with newly diagnosed AL was used to measure hs-cTnT, cTnT, and NT-proBNP. Survival modelling was performed. Results: The direct numeric result from hs-cTnT measurement cannot merely be substituted for a cTnT measurement in the Mayo AL staging system. The performance of the receiver operator curve derived an hs-cTnT cut-point of 54 ng/L which improves on the value of 35 ng/L validated with the prior iteration of the assay. An alternate staging option using hs-cTnT alone --using the two thresholds 14 ng/L and 54 ng/L-- performs as well as either the original Mayo AL staging system or other systems incorporating hs-cTnT. On multivariate analysis, an hs-cTnT alone staging system was independent of period of diagnosis, type of therapy, and NT-proBNP value, the last of which dropped out of the model. Alternate models were explored, but none performed better than the original system or the new hscTnT system. Thus, hs-cTnT can be used alone for the staging of disease prognosis. Conclusions: A survival model based on hs-cTnT improves the prognostic staging of patients with AL amyloidosis, relegating NT-proBNP to a measure of cardiac response.


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