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Caselli C, Prontera C, Liga R, De Graaf MA, Gaemperli O, Lorenzoni V, Ragusa R, Marinelli M, Del Ry S, Rovai D, Giannessi D, Aguade-Bruix S, Clemente A, Bax JJ, Lombardi M, Sicari R, Zamorano J, Scholte AJ, Kaufmann PA, Knuuti J, Underwood SR, Clerico A, Neglia D. Effect of Coronary Atherosclerosis and Myocardial Ischemia on Plasma Levels of High-Sensitivity Troponin T and NT-proBNP in Patients With Stable Angina. Arterioscler Thromb Vasc Biol 2016; 36:757-64. [PMID: 26868212 DOI: 10.1161/atvbaha.115.306818] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 02/01/2016] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Circulating levels of high-sensitivity cardiac troponin T (hs-cTnT) and N terminal pro brain natriuretic peptide (NT-proBNP) are predictors of prognosis in patients with coronary artery disease (CAD). We aimed at evaluating the effect of coronary atherosclerosis and myocardial ischemia on cardiac release of hs-cTnT and NT-proBNP in patients with suspected CAD. APPROACH AND RESULTS Hs-cTnT and NT-proBNP were measured in 378 patients (60.1±0.5 years, 229 males) with stable angina and unknown CAD enrolled in the Evaluation of Integrated Cardiac Imaging (EVINCI) study. All patients underwent stress imaging to detect myocardial ischemia and coronary computed tomographic angiography to assess the presence and characteristics of CAD. An individual computed tomographic angiography score was calculated combining extent, severity, composition, and location of plaques. In the whole population, the median (25-75 percentiles) value of plasma hs-cTnT was 6.17 (4.2-9.1) ng/L and of NT-proBNP was 61.66 (31.2-132.6) ng/L. In a multivariate model, computed tomographic angiography score was an independent predictor of the plasma hs-cTnT (coefficient 0.06, SE 0.02; P=0.0089), whereas ischemia was a predictor of NT-proBNP (coefficient 0.38, SE 0.12; P=0.0015). Hs-cTnT concentrations were significantly increased in patients with CAD with or without myocardial ischemia (P<0.005), whereas only patients with CAD and ischemia showed significantly higher levels of NT-proBNP (P<0.001). CONCLUSIONS In patients with stable angina, the presence and extent of coronary atherosclerosis is related with circulating levels of hs-cTnT, also in the absence of ischemia, suggesting an ischemia-independent mechanism of hs-cTnT release. Obstructive CAD causing myocardial ischemia is associated with increased levels of NT-proBNP.
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Affiliation(s)
- Chiara Caselli
- From the CNR, Institute of Clinical Physiology, Pisa, Italy (C.C., M.M., S.D.R., D.R., D.G., R.S., D.N.); Fondazione Toscana G. Monasterio, Pisa, Italy (C.P., A.C., M.L., A.C., D.N.); Cardio-Thoracic and Vascular Department, University Hospital of Pisa, Italy (R.L.); Leiden University Medical Center, Leiden, The Netherlands (M.A.D.G., J.J.B., A.J.S.); University Hospital Zurich, Zurich, Switzerland (O.G., P.A.K.); Scuola Superiore Sant'Anna, Pisa, Italy (V.L., R.R., A.C.); Hospital Universitario Vall d'Hebron, Barcelona, Spain (S.A.-B.); University Alcala, Hospital Ramón y Cajal, Madrid, Spain (J.Z.); University of Turku and Turku University Hospital, Turku, Finland (J.K.); and Imperial College London, United Kingdom (S.R.U.).
| | - Concetta Prontera
- From the CNR, Institute of Clinical Physiology, Pisa, Italy (C.C., M.M., S.D.R., D.R., D.G., R.S., D.N.); Fondazione Toscana G. Monasterio, Pisa, Italy (C.P., A.C., M.L., A.C., D.N.); Cardio-Thoracic and Vascular Department, University Hospital of Pisa, Italy (R.L.); Leiden University Medical Center, Leiden, The Netherlands (M.A.D.G., J.J.B., A.J.S.); University Hospital Zurich, Zurich, Switzerland (O.G., P.A.K.); Scuola Superiore Sant'Anna, Pisa, Italy (V.L., R.R., A.C.); Hospital Universitario Vall d'Hebron, Barcelona, Spain (S.A.-B.); University Alcala, Hospital Ramón y Cajal, Madrid, Spain (J.Z.); University of Turku and Turku University Hospital, Turku, Finland (J.K.); and Imperial College London, United Kingdom (S.R.U.)
| | - Riccardo Liga
- From the CNR, Institute of Clinical Physiology, Pisa, Italy (C.C., M.M., S.D.R., D.R., D.G., R.S., D.N.); Fondazione Toscana G. Monasterio, Pisa, Italy (C.P., A.C., M.L., A.C., D.N.); Cardio-Thoracic and Vascular Department, University Hospital of Pisa, Italy (R.L.); Leiden University Medical Center, Leiden, The Netherlands (M.A.D.G., J.J.B., A.J.S.); University Hospital Zurich, Zurich, Switzerland (O.G., P.A.K.); Scuola Superiore Sant'Anna, Pisa, Italy (V.L., R.R., A.C.); Hospital Universitario Vall d'Hebron, Barcelona, Spain (S.A.-B.); University Alcala, Hospital Ramón y Cajal, Madrid, Spain (J.Z.); University of Turku and Turku University Hospital, Turku, Finland (J.K.); and Imperial College London, United Kingdom (S.R.U.)
| | - Michiel A De Graaf
- From the CNR, Institute of Clinical Physiology, Pisa, Italy (C.C., M.M., S.D.R., D.R., D.G., R.S., D.N.); Fondazione Toscana G. Monasterio, Pisa, Italy (C.P., A.C., M.L., A.C., D.N.); Cardio-Thoracic and Vascular Department, University Hospital of Pisa, Italy (R.L.); Leiden University Medical Center, Leiden, The Netherlands (M.A.D.G., J.J.B., A.J.S.); University Hospital Zurich, Zurich, Switzerland (O.G., P.A.K.); Scuola Superiore Sant'Anna, Pisa, Italy (V.L., R.R., A.C.); Hospital Universitario Vall d'Hebron, Barcelona, Spain (S.A.-B.); University Alcala, Hospital Ramón y Cajal, Madrid, Spain (J.Z.); University of Turku and Turku University Hospital, Turku, Finland (J.K.); and Imperial College London, United Kingdom (S.R.U.)
| | - Oliver Gaemperli
- From the CNR, Institute of Clinical Physiology, Pisa, Italy (C.C., M.M., S.D.R., D.R., D.G., R.S., D.N.); Fondazione Toscana G. Monasterio, Pisa, Italy (C.P., A.C., M.L., A.C., D.N.); Cardio-Thoracic and Vascular Department, University Hospital of Pisa, Italy (R.L.); Leiden University Medical Center, Leiden, The Netherlands (M.A.D.G., J.J.B., A.J.S.); University Hospital Zurich, Zurich, Switzerland (O.G., P.A.K.); Scuola Superiore Sant'Anna, Pisa, Italy (V.L., R.R., A.C.); Hospital Universitario Vall d'Hebron, Barcelona, Spain (S.A.-B.); University Alcala, Hospital Ramón y Cajal, Madrid, Spain (J.Z.); University of Turku and Turku University Hospital, Turku, Finland (J.K.); and Imperial College London, United Kingdom (S.R.U.)
| | - Valentina Lorenzoni
- From the CNR, Institute of Clinical Physiology, Pisa, Italy (C.C., M.M., S.D.R., D.R., D.G., R.S., D.N.); Fondazione Toscana G. Monasterio, Pisa, Italy (C.P., A.C., M.L., A.C., D.N.); Cardio-Thoracic and Vascular Department, University Hospital of Pisa, Italy (R.L.); Leiden University Medical Center, Leiden, The Netherlands (M.A.D.G., J.J.B., A.J.S.); University Hospital Zurich, Zurich, Switzerland (O.G., P.A.K.); Scuola Superiore Sant'Anna, Pisa, Italy (V.L., R.R., A.C.); Hospital Universitario Vall d'Hebron, Barcelona, Spain (S.A.-B.); University Alcala, Hospital Ramón y Cajal, Madrid, Spain (J.Z.); University of Turku and Turku University Hospital, Turku, Finland (J.K.); and Imperial College London, United Kingdom (S.R.U.)
| | - Rosetta Ragusa
- From the CNR, Institute of Clinical Physiology, Pisa, Italy (C.C., M.M., S.D.R., D.R., D.G., R.S., D.N.); Fondazione Toscana G. Monasterio, Pisa, Italy (C.P., A.C., M.L., A.C., D.N.); Cardio-Thoracic and Vascular Department, University Hospital of Pisa, Italy (R.L.); Leiden University Medical Center, Leiden, The Netherlands (M.A.D.G., J.J.B., A.J.S.); University Hospital Zurich, Zurich, Switzerland (O.G., P.A.K.); Scuola Superiore Sant'Anna, Pisa, Italy (V.L., R.R., A.C.); Hospital Universitario Vall d'Hebron, Barcelona, Spain (S.A.-B.); University Alcala, Hospital Ramón y Cajal, Madrid, Spain (J.Z.); University of Turku and Turku University Hospital, Turku, Finland (J.K.); and Imperial College London, United Kingdom (S.R.U.)
| | - Martina Marinelli
- From the CNR, Institute of Clinical Physiology, Pisa, Italy (C.C., M.M., S.D.R., D.R., D.G., R.S., D.N.); Fondazione Toscana G. Monasterio, Pisa, Italy (C.P., A.C., M.L., A.C., D.N.); Cardio-Thoracic and Vascular Department, University Hospital of Pisa, Italy (R.L.); Leiden University Medical Center, Leiden, The Netherlands (M.A.D.G., J.J.B., A.J.S.); University Hospital Zurich, Zurich, Switzerland (O.G., P.A.K.); Scuola Superiore Sant'Anna, Pisa, Italy (V.L., R.R., A.C.); Hospital Universitario Vall d'Hebron, Barcelona, Spain (S.A.-B.); University Alcala, Hospital Ramón y Cajal, Madrid, Spain (J.Z.); University of Turku and Turku University Hospital, Turku, Finland (J.K.); and Imperial College London, United Kingdom (S.R.U.)
| | - Silvia Del Ry
- From the CNR, Institute of Clinical Physiology, Pisa, Italy (C.C., M.M., S.D.R., D.R., D.G., R.S., D.N.); Fondazione Toscana G. Monasterio, Pisa, Italy (C.P., A.C., M.L., A.C., D.N.); Cardio-Thoracic and Vascular Department, University Hospital of Pisa, Italy (R.L.); Leiden University Medical Center, Leiden, The Netherlands (M.A.D.G., J.J.B., A.J.S.); University Hospital Zurich, Zurich, Switzerland (O.G., P.A.K.); Scuola Superiore Sant'Anna, Pisa, Italy (V.L., R.R., A.C.); Hospital Universitario Vall d'Hebron, Barcelona, Spain (S.A.-B.); University Alcala, Hospital Ramón y Cajal, Madrid, Spain (J.Z.); University of Turku and Turku University Hospital, Turku, Finland (J.K.); and Imperial College London, United Kingdom (S.R.U.)
| | - Daniele Rovai
- From the CNR, Institute of Clinical Physiology, Pisa, Italy (C.C., M.M., S.D.R., D.R., D.G., R.S., D.N.); Fondazione Toscana G. Monasterio, Pisa, Italy (C.P., A.C., M.L., A.C., D.N.); Cardio-Thoracic and Vascular Department, University Hospital of Pisa, Italy (R.L.); Leiden University Medical Center, Leiden, The Netherlands (M.A.D.G., J.J.B., A.J.S.); University Hospital Zurich, Zurich, Switzerland (O.G., P.A.K.); Scuola Superiore Sant'Anna, Pisa, Italy (V.L., R.R., A.C.); Hospital Universitario Vall d'Hebron, Barcelona, Spain (S.A.-B.); University Alcala, Hospital Ramón y Cajal, Madrid, Spain (J.Z.); University of Turku and Turku University Hospital, Turku, Finland (J.K.); and Imperial College London, United Kingdom (S.R.U.)
| | - Daniela Giannessi
- From the CNR, Institute of Clinical Physiology, Pisa, Italy (C.C., M.M., S.D.R., D.R., D.G., R.S., D.N.); Fondazione Toscana G. Monasterio, Pisa, Italy (C.P., A.C., M.L., A.C., D.N.); Cardio-Thoracic and Vascular Department, University Hospital of Pisa, Italy (R.L.); Leiden University Medical Center, Leiden, The Netherlands (M.A.D.G., J.J.B., A.J.S.); University Hospital Zurich, Zurich, Switzerland (O.G., P.A.K.); Scuola Superiore Sant'Anna, Pisa, Italy (V.L., R.R., A.C.); Hospital Universitario Vall d'Hebron, Barcelona, Spain (S.A.-B.); University Alcala, Hospital Ramón y Cajal, Madrid, Spain (J.Z.); University of Turku and Turku University Hospital, Turku, Finland (J.K.); and Imperial College London, United Kingdom (S.R.U.)
| | - Santiago Aguade-Bruix
- From the CNR, Institute of Clinical Physiology, Pisa, Italy (C.C., M.M., S.D.R., D.R., D.G., R.S., D.N.); Fondazione Toscana G. Monasterio, Pisa, Italy (C.P., A.C., M.L., A.C., D.N.); Cardio-Thoracic and Vascular Department, University Hospital of Pisa, Italy (R.L.); Leiden University Medical Center, Leiden, The Netherlands (M.A.D.G., J.J.B., A.J.S.); University Hospital Zurich, Zurich, Switzerland (O.G., P.A.K.); Scuola Superiore Sant'Anna, Pisa, Italy (V.L., R.R., A.C.); Hospital Universitario Vall d'Hebron, Barcelona, Spain (S.A.-B.); University Alcala, Hospital Ramón y Cajal, Madrid, Spain (J.Z.); University of Turku and Turku University Hospital, Turku, Finland (J.K.); and Imperial College London, United Kingdom (S.R.U.)
| | - Alberto Clemente
- From the CNR, Institute of Clinical Physiology, Pisa, Italy (C.C., M.M., S.D.R., D.R., D.G., R.S., D.N.); Fondazione Toscana G. Monasterio, Pisa, Italy (C.P., A.C., M.L., A.C., D.N.); Cardio-Thoracic and Vascular Department, University Hospital of Pisa, Italy (R.L.); Leiden University Medical Center, Leiden, The Netherlands (M.A.D.G., J.J.B., A.J.S.); University Hospital Zurich, Zurich, Switzerland (O.G., P.A.K.); Scuola Superiore Sant'Anna, Pisa, Italy (V.L., R.R., A.C.); Hospital Universitario Vall d'Hebron, Barcelona, Spain (S.A.-B.); University Alcala, Hospital Ramón y Cajal, Madrid, Spain (J.Z.); University of Turku and Turku University Hospital, Turku, Finland (J.K.); and Imperial College London, United Kingdom (S.R.U.)
| | - Jeroen J Bax
- From the CNR, Institute of Clinical Physiology, Pisa, Italy (C.C., M.M., S.D.R., D.R., D.G., R.S., D.N.); Fondazione Toscana G. Monasterio, Pisa, Italy (C.P., A.C., M.L., A.C., D.N.); Cardio-Thoracic and Vascular Department, University Hospital of Pisa, Italy (R.L.); Leiden University Medical Center, Leiden, The Netherlands (M.A.D.G., J.J.B., A.J.S.); University Hospital Zurich, Zurich, Switzerland (O.G., P.A.K.); Scuola Superiore Sant'Anna, Pisa, Italy (V.L., R.R., A.C.); Hospital Universitario Vall d'Hebron, Barcelona, Spain (S.A.-B.); University Alcala, Hospital Ramón y Cajal, Madrid, Spain (J.Z.); University of Turku and Turku University Hospital, Turku, Finland (J.K.); and Imperial College London, United Kingdom (S.R.U.)
| | - Massimo Lombardi
- From the CNR, Institute of Clinical Physiology, Pisa, Italy (C.C., M.M., S.D.R., D.R., D.G., R.S., D.N.); Fondazione Toscana G. Monasterio, Pisa, Italy (C.P., A.C., M.L., A.C., D.N.); Cardio-Thoracic and Vascular Department, University Hospital of Pisa, Italy (R.L.); Leiden University Medical Center, Leiden, The Netherlands (M.A.D.G., J.J.B., A.J.S.); University Hospital Zurich, Zurich, Switzerland (O.G., P.A.K.); Scuola Superiore Sant'Anna, Pisa, Italy (V.L., R.R., A.C.); Hospital Universitario Vall d'Hebron, Barcelona, Spain (S.A.-B.); University Alcala, Hospital Ramón y Cajal, Madrid, Spain (J.Z.); University of Turku and Turku University Hospital, Turku, Finland (J.K.); and Imperial College London, United Kingdom (S.R.U.)
| | - Rosa Sicari
- From the CNR, Institute of Clinical Physiology, Pisa, Italy (C.C., M.M., S.D.R., D.R., D.G., R.S., D.N.); Fondazione Toscana G. Monasterio, Pisa, Italy (C.P., A.C., M.L., A.C., D.N.); Cardio-Thoracic and Vascular Department, University Hospital of Pisa, Italy (R.L.); Leiden University Medical Center, Leiden, The Netherlands (M.A.D.G., J.J.B., A.J.S.); University Hospital Zurich, Zurich, Switzerland (O.G., P.A.K.); Scuola Superiore Sant'Anna, Pisa, Italy (V.L., R.R., A.C.); Hospital Universitario Vall d'Hebron, Barcelona, Spain (S.A.-B.); University Alcala, Hospital Ramón y Cajal, Madrid, Spain (J.Z.); University of Turku and Turku University Hospital, Turku, Finland (J.K.); and Imperial College London, United Kingdom (S.R.U.)
| | - José Zamorano
- From the CNR, Institute of Clinical Physiology, Pisa, Italy (C.C., M.M., S.D.R., D.R., D.G., R.S., D.N.); Fondazione Toscana G. Monasterio, Pisa, Italy (C.P., A.C., M.L., A.C., D.N.); Cardio-Thoracic and Vascular Department, University Hospital of Pisa, Italy (R.L.); Leiden University Medical Center, Leiden, The Netherlands (M.A.D.G., J.J.B., A.J.S.); University Hospital Zurich, Zurich, Switzerland (O.G., P.A.K.); Scuola Superiore Sant'Anna, Pisa, Italy (V.L., R.R., A.C.); Hospital Universitario Vall d'Hebron, Barcelona, Spain (S.A.-B.); University Alcala, Hospital Ramón y Cajal, Madrid, Spain (J.Z.); University of Turku and Turku University Hospital, Turku, Finland (J.K.); and Imperial College London, United Kingdom (S.R.U.)
| | - Arthur J Scholte
- From the CNR, Institute of Clinical Physiology, Pisa, Italy (C.C., M.M., S.D.R., D.R., D.G., R.S., D.N.); Fondazione Toscana G. Monasterio, Pisa, Italy (C.P., A.C., M.L., A.C., D.N.); Cardio-Thoracic and Vascular Department, University Hospital of Pisa, Italy (R.L.); Leiden University Medical Center, Leiden, The Netherlands (M.A.D.G., J.J.B., A.J.S.); University Hospital Zurich, Zurich, Switzerland (O.G., P.A.K.); Scuola Superiore Sant'Anna, Pisa, Italy (V.L., R.R., A.C.); Hospital Universitario Vall d'Hebron, Barcelona, Spain (S.A.-B.); University Alcala, Hospital Ramón y Cajal, Madrid, Spain (J.Z.); University of Turku and Turku University Hospital, Turku, Finland (J.K.); and Imperial College London, United Kingdom (S.R.U.)
| | - Philipp A Kaufmann
- From the CNR, Institute of Clinical Physiology, Pisa, Italy (C.C., M.M., S.D.R., D.R., D.G., R.S., D.N.); Fondazione Toscana G. Monasterio, Pisa, Italy (C.P., A.C., M.L., A.C., D.N.); Cardio-Thoracic and Vascular Department, University Hospital of Pisa, Italy (R.L.); Leiden University Medical Center, Leiden, The Netherlands (M.A.D.G., J.J.B., A.J.S.); University Hospital Zurich, Zurich, Switzerland (O.G., P.A.K.); Scuola Superiore Sant'Anna, Pisa, Italy (V.L., R.R., A.C.); Hospital Universitario Vall d'Hebron, Barcelona, Spain (S.A.-B.); University Alcala, Hospital Ramón y Cajal, Madrid, Spain (J.Z.); University of Turku and Turku University Hospital, Turku, Finland (J.K.); and Imperial College London, United Kingdom (S.R.U.)
| | - Juhani Knuuti
- From the CNR, Institute of Clinical Physiology, Pisa, Italy (C.C., M.M., S.D.R., D.R., D.G., R.S., D.N.); Fondazione Toscana G. Monasterio, Pisa, Italy (C.P., A.C., M.L., A.C., D.N.); Cardio-Thoracic and Vascular Department, University Hospital of Pisa, Italy (R.L.); Leiden University Medical Center, Leiden, The Netherlands (M.A.D.G., J.J.B., A.J.S.); University Hospital Zurich, Zurich, Switzerland (O.G., P.A.K.); Scuola Superiore Sant'Anna, Pisa, Italy (V.L., R.R., A.C.); Hospital Universitario Vall d'Hebron, Barcelona, Spain (S.A.-B.); University Alcala, Hospital Ramón y Cajal, Madrid, Spain (J.Z.); University of Turku and Turku University Hospital, Turku, Finland (J.K.); and Imperial College London, United Kingdom (S.R.U.)
| | - S Richard Underwood
- From the CNR, Institute of Clinical Physiology, Pisa, Italy (C.C., M.M., S.D.R., D.R., D.G., R.S., D.N.); Fondazione Toscana G. Monasterio, Pisa, Italy (C.P., A.C., M.L., A.C., D.N.); Cardio-Thoracic and Vascular Department, University Hospital of Pisa, Italy (R.L.); Leiden University Medical Center, Leiden, The Netherlands (M.A.D.G., J.J.B., A.J.S.); University Hospital Zurich, Zurich, Switzerland (O.G., P.A.K.); Scuola Superiore Sant'Anna, Pisa, Italy (V.L., R.R., A.C.); Hospital Universitario Vall d'Hebron, Barcelona, Spain (S.A.-B.); University Alcala, Hospital Ramón y Cajal, Madrid, Spain (J.Z.); University of Turku and Turku University Hospital, Turku, Finland (J.K.); and Imperial College London, United Kingdom (S.R.U.)
| | - Aldo Clerico
- From the CNR, Institute of Clinical Physiology, Pisa, Italy (C.C., M.M., S.D.R., D.R., D.G., R.S., D.N.); Fondazione Toscana G. Monasterio, Pisa, Italy (C.P., A.C., M.L., A.C., D.N.); Cardio-Thoracic and Vascular Department, University Hospital of Pisa, Italy (R.L.); Leiden University Medical Center, Leiden, The Netherlands (M.A.D.G., J.J.B., A.J.S.); University Hospital Zurich, Zurich, Switzerland (O.G., P.A.K.); Scuola Superiore Sant'Anna, Pisa, Italy (V.L., R.R., A.C.); Hospital Universitario Vall d'Hebron, Barcelona, Spain (S.A.-B.); University Alcala, Hospital Ramón y Cajal, Madrid, Spain (J.Z.); University of Turku and Turku University Hospital, Turku, Finland (J.K.); and Imperial College London, United Kingdom (S.R.U.)
| | - Danilo Neglia
- From the CNR, Institute of Clinical Physiology, Pisa, Italy (C.C., M.M., S.D.R., D.R., D.G., R.S., D.N.); Fondazione Toscana G. Monasterio, Pisa, Italy (C.P., A.C., M.L., A.C., D.N.); Cardio-Thoracic and Vascular Department, University Hospital of Pisa, Italy (R.L.); Leiden University Medical Center, Leiden, The Netherlands (M.A.D.G., J.J.B., A.J.S.); University Hospital Zurich, Zurich, Switzerland (O.G., P.A.K.); Scuola Superiore Sant'Anna, Pisa, Italy (V.L., R.R., A.C.); Hospital Universitario Vall d'Hebron, Barcelona, Spain (S.A.-B.); University Alcala, Hospital Ramón y Cajal, Madrid, Spain (J.Z.); University of Turku and Turku University Hospital, Turku, Finland (J.K.); and Imperial College London, United Kingdom (S.R.U.)
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Wens SC, Schaaf GJ, Michels M, Kruijshaar ME, van Gestel TJ, in ‘t Groen S, Pijnenburg J, Dekkers DH, Demmers JA, Verdijk LB, Brusse E, van Schaik RH, van der Ploeg AT, van Doorn PA, Pijnappel WP. Elevated Plasma Cardiac Troponin T Levels Caused by Skeletal Muscle Damage in Pompe Disease. ACTA ACUST UNITED AC 2016; 9:6-13. [DOI: 10.1161/circgenetics.115.001322] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 01/14/2016] [Indexed: 01/19/2023]
Abstract
Background—
Elevated plasma cardiac troponin T (cTnT) levels in patients with neuromuscular disorders may erroneously lead to the diagnosis of acute myocardial infarction or myocardial injury.
Methods and Results—
In 122 patients with Pompe disease, the relationship between cTnT, cardiac troponin I, creatine kinase (CK), CK-myocardial band levels, and skeletal muscle damage was assessed. ECG and echocardiography were used to evaluate possible cardiac disease. Patients were divided into classic infantile, childhood-onset, and adult-onset patients. cTnT levels were elevated in 82% of patients (median 27 ng/L, normal values <14 ng/L). Cardiac troponin I levels were normal in all patients, whereas CK-myocardial band levels were increased in 59% of patients. cTnT levels correlated with CK levels in all 3 subgroups (
P
<0.001). None of the abnormal ECGs recorded in 21 patients were indicative of acute myocardial infarction, and there were no differences in cTnT levels between patients with and without (n=90) abnormalities on ECG (median 28 ng/L in both groups). The median left ventricular mass index measured with echocardiography was normal in all the 3 subgroups. cTnT mRNA expression in skeletal muscle was not detectable in controls but was strongly induced in patients with Pompe disease. cTnT protein was identified by mass spectrometry in patient-derived skeletal muscle tissue.
Conclusions—
Elevated plasma cTnT levels in patients with Pompe disease are associated with skeletal muscle damage, rather than acute myocardial injury. Increased cTnT levels in Pompe disease and likely other neuromuscular disorders should be interpreted with caution to avoid unnecessary cardiac interventions.
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Affiliation(s)
- Stephan C.A. Wens
- From the Department of Neurology (S.C.A.W., E.B., P.A.v.D.), Center for Lysosomal and Metabolic Diseases (S.C.A.W., G.J.S., M.E.K., T.J.M.v.G., S.G., J.P., E.B., A.T.v.d.P., P.A.v.D., W.W.M.P.P.), Molecular Stem Cell Biology, Department of Clinical Genetics (G.J.S., T.J.M.v.G., S.G., J.P., W.W.M.P.P.), Department of Cardiology (M.M.), Department of Clinical Chemistry (R.H.N.v.S.), Erasmus MC University Medical Center, Rotterdam, The Netherlands; Division of Metabolic Diseases and Genetics,
| | - Gerben J. Schaaf
- From the Department of Neurology (S.C.A.W., E.B., P.A.v.D.), Center for Lysosomal and Metabolic Diseases (S.C.A.W., G.J.S., M.E.K., T.J.M.v.G., S.G., J.P., E.B., A.T.v.d.P., P.A.v.D., W.W.M.P.P.), Molecular Stem Cell Biology, Department of Clinical Genetics (G.J.S., T.J.M.v.G., S.G., J.P., W.W.M.P.P.), Department of Cardiology (M.M.), Department of Clinical Chemistry (R.H.N.v.S.), Erasmus MC University Medical Center, Rotterdam, The Netherlands; Division of Metabolic Diseases and Genetics,
| | - Michelle Michels
- From the Department of Neurology (S.C.A.W., E.B., P.A.v.D.), Center for Lysosomal and Metabolic Diseases (S.C.A.W., G.J.S., M.E.K., T.J.M.v.G., S.G., J.P., E.B., A.T.v.d.P., P.A.v.D., W.W.M.P.P.), Molecular Stem Cell Biology, Department of Clinical Genetics (G.J.S., T.J.M.v.G., S.G., J.P., W.W.M.P.P.), Department of Cardiology (M.M.), Department of Clinical Chemistry (R.H.N.v.S.), Erasmus MC University Medical Center, Rotterdam, The Netherlands; Division of Metabolic Diseases and Genetics,
| | - Michelle E. Kruijshaar
- From the Department of Neurology (S.C.A.W., E.B., P.A.v.D.), Center for Lysosomal and Metabolic Diseases (S.C.A.W., G.J.S., M.E.K., T.J.M.v.G., S.G., J.P., E.B., A.T.v.d.P., P.A.v.D., W.W.M.P.P.), Molecular Stem Cell Biology, Department of Clinical Genetics (G.J.S., T.J.M.v.G., S.G., J.P., W.W.M.P.P.), Department of Cardiology (M.M.), Department of Clinical Chemistry (R.H.N.v.S.), Erasmus MC University Medical Center, Rotterdam, The Netherlands; Division of Metabolic Diseases and Genetics,
| | - Tom J.M. van Gestel
- From the Department of Neurology (S.C.A.W., E.B., P.A.v.D.), Center for Lysosomal and Metabolic Diseases (S.C.A.W., G.J.S., M.E.K., T.J.M.v.G., S.G., J.P., E.B., A.T.v.d.P., P.A.v.D., W.W.M.P.P.), Molecular Stem Cell Biology, Department of Clinical Genetics (G.J.S., T.J.M.v.G., S.G., J.P., W.W.M.P.P.), Department of Cardiology (M.M.), Department of Clinical Chemistry (R.H.N.v.S.), Erasmus MC University Medical Center, Rotterdam, The Netherlands; Division of Metabolic Diseases and Genetics,
| | - Stijn in ‘t Groen
- From the Department of Neurology (S.C.A.W., E.B., P.A.v.D.), Center for Lysosomal and Metabolic Diseases (S.C.A.W., G.J.S., M.E.K., T.J.M.v.G., S.G., J.P., E.B., A.T.v.d.P., P.A.v.D., W.W.M.P.P.), Molecular Stem Cell Biology, Department of Clinical Genetics (G.J.S., T.J.M.v.G., S.G., J.P., W.W.M.P.P.), Department of Cardiology (M.M.), Department of Clinical Chemistry (R.H.N.v.S.), Erasmus MC University Medical Center, Rotterdam, The Netherlands; Division of Metabolic Diseases and Genetics,
| | - Joon Pijnenburg
- From the Department of Neurology (S.C.A.W., E.B., P.A.v.D.), Center for Lysosomal and Metabolic Diseases (S.C.A.W., G.J.S., M.E.K., T.J.M.v.G., S.G., J.P., E.B., A.T.v.d.P., P.A.v.D., W.W.M.P.P.), Molecular Stem Cell Biology, Department of Clinical Genetics (G.J.S., T.J.M.v.G., S.G., J.P., W.W.M.P.P.), Department of Cardiology (M.M.), Department of Clinical Chemistry (R.H.N.v.S.), Erasmus MC University Medical Center, Rotterdam, The Netherlands; Division of Metabolic Diseases and Genetics,
| | - Dick H.W. Dekkers
- From the Department of Neurology (S.C.A.W., E.B., P.A.v.D.), Center for Lysosomal and Metabolic Diseases (S.C.A.W., G.J.S., M.E.K., T.J.M.v.G., S.G., J.P., E.B., A.T.v.d.P., P.A.v.D., W.W.M.P.P.), Molecular Stem Cell Biology, Department of Clinical Genetics (G.J.S., T.J.M.v.G., S.G., J.P., W.W.M.P.P.), Department of Cardiology (M.M.), Department of Clinical Chemistry (R.H.N.v.S.), Erasmus MC University Medical Center, Rotterdam, The Netherlands; Division of Metabolic Diseases and Genetics,
| | - Jeroen A.A. Demmers
- From the Department of Neurology (S.C.A.W., E.B., P.A.v.D.), Center for Lysosomal and Metabolic Diseases (S.C.A.W., G.J.S., M.E.K., T.J.M.v.G., S.G., J.P., E.B., A.T.v.d.P., P.A.v.D., W.W.M.P.P.), Molecular Stem Cell Biology, Department of Clinical Genetics (G.J.S., T.J.M.v.G., S.G., J.P., W.W.M.P.P.), Department of Cardiology (M.M.), Department of Clinical Chemistry (R.H.N.v.S.), Erasmus MC University Medical Center, Rotterdam, The Netherlands; Division of Metabolic Diseases and Genetics,
| | - Lex B. Verdijk
- From the Department of Neurology (S.C.A.W., E.B., P.A.v.D.), Center for Lysosomal and Metabolic Diseases (S.C.A.W., G.J.S., M.E.K., T.J.M.v.G., S.G., J.P., E.B., A.T.v.d.P., P.A.v.D., W.W.M.P.P.), Molecular Stem Cell Biology, Department of Clinical Genetics (G.J.S., T.J.M.v.G., S.G., J.P., W.W.M.P.P.), Department of Cardiology (M.M.), Department of Clinical Chemistry (R.H.N.v.S.), Erasmus MC University Medical Center, Rotterdam, The Netherlands; Division of Metabolic Diseases and Genetics,
| | - Esther Brusse
- From the Department of Neurology (S.C.A.W., E.B., P.A.v.D.), Center for Lysosomal and Metabolic Diseases (S.C.A.W., G.J.S., M.E.K., T.J.M.v.G., S.G., J.P., E.B., A.T.v.d.P., P.A.v.D., W.W.M.P.P.), Molecular Stem Cell Biology, Department of Clinical Genetics (G.J.S., T.J.M.v.G., S.G., J.P., W.W.M.P.P.), Department of Cardiology (M.M.), Department of Clinical Chemistry (R.H.N.v.S.), Erasmus MC University Medical Center, Rotterdam, The Netherlands; Division of Metabolic Diseases and Genetics,
| | - Ron H.N. van Schaik
- From the Department of Neurology (S.C.A.W., E.B., P.A.v.D.), Center for Lysosomal and Metabolic Diseases (S.C.A.W., G.J.S., M.E.K., T.J.M.v.G., S.G., J.P., E.B., A.T.v.d.P., P.A.v.D., W.W.M.P.P.), Molecular Stem Cell Biology, Department of Clinical Genetics (G.J.S., T.J.M.v.G., S.G., J.P., W.W.M.P.P.), Department of Cardiology (M.M.), Department of Clinical Chemistry (R.H.N.v.S.), Erasmus MC University Medical Center, Rotterdam, The Netherlands; Division of Metabolic Diseases and Genetics,
| | - Ans T. van der Ploeg
- From the Department of Neurology (S.C.A.W., E.B., P.A.v.D.), Center for Lysosomal and Metabolic Diseases (S.C.A.W., G.J.S., M.E.K., T.J.M.v.G., S.G., J.P., E.B., A.T.v.d.P., P.A.v.D., W.W.M.P.P.), Molecular Stem Cell Biology, Department of Clinical Genetics (G.J.S., T.J.M.v.G., S.G., J.P., W.W.M.P.P.), Department of Cardiology (M.M.), Department of Clinical Chemistry (R.H.N.v.S.), Erasmus MC University Medical Center, Rotterdam, The Netherlands; Division of Metabolic Diseases and Genetics,
| | - Pieter A. van Doorn
- From the Department of Neurology (S.C.A.W., E.B., P.A.v.D.), Center for Lysosomal and Metabolic Diseases (S.C.A.W., G.J.S., M.E.K., T.J.M.v.G., S.G., J.P., E.B., A.T.v.d.P., P.A.v.D., W.W.M.P.P.), Molecular Stem Cell Biology, Department of Clinical Genetics (G.J.S., T.J.M.v.G., S.G., J.P., W.W.M.P.P.), Department of Cardiology (M.M.), Department of Clinical Chemistry (R.H.N.v.S.), Erasmus MC University Medical Center, Rotterdam, The Netherlands; Division of Metabolic Diseases and Genetics,
| | - W.W.M. Pim Pijnappel
- From the Department of Neurology (S.C.A.W., E.B., P.A.v.D.), Center for Lysosomal and Metabolic Diseases (S.C.A.W., G.J.S., M.E.K., T.J.M.v.G., S.G., J.P., E.B., A.T.v.d.P., P.A.v.D., W.W.M.P.P.), Molecular Stem Cell Biology, Department of Clinical Genetics (G.J.S., T.J.M.v.G., S.G., J.P., W.W.M.P.P.), Department of Cardiology (M.M.), Department of Clinical Chemistry (R.H.N.v.S.), Erasmus MC University Medical Center, Rotterdam, The Netherlands; Division of Metabolic Diseases and Genetics,
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