Arthritis & Rheumatism, Volume 63,
November 2011 Abstract Supplement
Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Chicago, Illinois November 4-9, 2011.
Ultra Sensitive Troponin in Systemic Sclerosis.
Meune1, Christophe, Avouac2, Jérôme, Gobeaux3, Camille, Meunier2, Marine, Kahan2, Andre, Allanore2, Yannick
Paris Descartes University, Cardiology department, Cochin Hospital, Paris, France
Paris Descartes University, Rheumatology A department, Cochin Hospital, Paris, France
Paris Descartes University, Biochemistry A department, Cochin Hospital, Paris, France
Microangiopathy is a cardinal feature of SSc that has a critical role in the development of primary myocardial involvement and possibly pulmonary hypertension. Cardiac troponin (cTn) is the recommended biomarker to detect myocardial injury. The recently developed high sensitive assays of cTn (hs-cTn) allow the measurement of concentration 20-fold lower than previously. Numerous studies have reported the high prognostic significance of these new assays; moreover some studies reported that hs-cTnT may be elevated in other condition than acute myocardial infarction, including acute and chronic myocardial ischemia. Our aim was to measure hs-cTn in SSc patients and to examine associated factors with elevated hs-cTn concentrations (99th percentile).
The plasma HScTnT concentrations were measured using an electrochemiluminescence immunoassay (Roche Diagnostic, Meylan, France) in consecutive stable SSc patients. The 99th percentile, with a CV £10% is achieved for 14 ng/L.
90 consecutive SSc patients were included (male 19, age 59±13 years, diffuse cutaneous form 30, disease duration 10.3±8.9 years). A single patient had LEVF <55%; reduced LV/RV contractility, as assessed by Tissue-Doppler echocardiography was detected in 18 patients (36.7%). Hs-cTnT concentration ranged between 3ng/l (the limit of detection) and 53ng/l, with 17 patients (19.5%) having elevated hs-cTnT concentration above 14ng/l (99th percentile). Hs-cTnT correlated with NT-proBNP (r=0.52, p<0.001). By univariate analysis, the following parameters were associated with increased hs-cTnT; age (p= 0.046), systolic pulmonary aterial pressure (p=0.012), the presence of anti-centromere antibodies (p=0.03), c-reactive protein (p=0.037), previous treatment with prednisone (p=0.046), and untreated hypertension (p=0.050). By bivariate analysis, after adjustment for age, the presence of elevated pulmonary artery pressure (sPAP>40mmHg) remained strongly associated with elevated versus normal hs-cTnT concentration (p=0.031).
Hs-cTnT, a strong prognosticator, might be elevated in SSc patient. It correlates with NT-proBNP, a marker of global myocardial involvement. The major determinants of SSc elevation were age, sPAP, ACA, and past prednisone treatment which may reflect the severity of the disease. Elevated pulmonary artery pressure remained the main associated factor with elevated versus normal hs-cTnT after adjustment for age. The capacity of hs-cTnT to predict pulmonary hypertension occurrence, as well as its prognostic significance, in the context of SSc remained to be established.
To cite this abstract, please use the following information:
Meune, Christophe, Avouac, Jérôme, Gobeaux, Camille, Meunier, Marine, Kahan, Andre, Allanore, Yannick; Ultra Sensitive Troponin in Systemic Sclerosis. [abstract]. Arthritis Rheum 2011;63 Suppl 10 :685