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

Alaa Salama; Ghada Ibrahim; Mohammad Fikry; Moataz Hassan Elsannan; Mohammad Eltahlawi

doi:10.1007/s12055-023-01594-5

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

Indian J Thorac Cardiovasc Surg. 2024 Mar;40(2):142-150. doi: 10.1007/s12055-023-01594-5. Epub 2023 Oct 25.

Authors

Alaa Salama¹, Ghada Ibrahim¹, Mohammad Fikry¹, Moataz Hassan Elsannan¹, Mohammad Eltahlawi¹

Affiliation

¹ Cardiology Department, Zagazig University, Zagazig, Egypt.

PMID: 38389769
PMCID: PMC10879475 (available on 2025-03-01)
DOI: 10.1007/s12055-023-01594-5

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.

Keywords: Aortic valve; MACE; Predictor; Troponin; Valve replacement.

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