Cardiomyopathy
Usefulness of Cardiac Troponins as Markers of Early Treatment Response in Cardiac Sarcoidosis

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Evaluation and treatment of cardiac sarcoidosis (CS) suffer from lack of sensitive and easily repeatable markers of disease activity. We studied measurements of high-sensitivity cardiac troponin T or troponin I (hs-cTnT/I) taken at presentation and during treatment in 62 patients with new-onset CS (48 women, mean age 49 years). Hs-cTnT was measured in 50 patients and was elevated (>13 ng/L) at presentation in 26 of them (52%). Hs-cTnI was measured in the remaining 12 patients and was elevated (>0.04 ng/mL) in 7 of them (58%). Left ventricular ejection fraction averaged 43 ± 14% in association with elevated hs-cTnT/I (n = 33) versus 53 ± 10% with normal hs-cTnT/I (n = 29; p = 0.001). Hs-cTnT/I was remeasured after 4 weeks of steroid therapy in 38 patients and was normalized in 16 of the 24 (67%) with an elevated pretreatment concentration and remained normal in the rest of the 14 patients (p <0.001). During follow-up (median, 17 months), cardiac death (n = 2), aborted sudden death (n = 5), sustained ventricular tachycardia (n = 8), or new complete atrioventricular block (n = 1) was recorded in 11 of 33 patients with elevated hs-cTnT/I versus in 5 of 29 with normal hs-cTnT/I (log-rank p = 0.068). Two-year event-free Kaplan-Meier cardiac survival estimate (95% confidence interval) was 67% (48% to 81%) with elevated hs-cTnT/I versus 93% (76% to 99%) with normal hs-cTnT/I. In CS, circulating hs-cTnT/I may help clinicians evaluate disease activity and treatment response. Their prognostic value remains tentative pending more follow-up data.

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Methods

We considered eligible for this retrospective work all patients diagnosed with new-onset CS from December 2010 to November 2014 in 6 Finnish hospitals participating in the Myocardial Inflammatory Diseases in Finland (MIDFIN) research network.15 To be included, the patient had to (1) have newly diagnosed histologically proved CS in conformity with our earlier criteria,10, 15 (2) be treatment naive, (3) have undergone measurements of hs-cTnT or hs-cTnI at the time diagnosis and after the start of

Results

Plasma hs-cTnT, measured in 50 patients, ranged from ≤13 to 240 ng/L at presentation (median, 15 ng/L) and was abnormally elevated (>13 ng/L) in 26 patients (52%). Hs-cTnI, measured in the remaining 12 patients, ranged from 0.01 to 1.30 ng/ml (median, 0.05 ng/ml) and was elevated (>0.04 ng/ml) in 7 patients (58%). Table 1 summarizes the characteristics of the study population and compares the subgroups of normal versus elevated hs-cTnT/I. The data show that elevated hs-cTnT/I was associated

Discussion

Our findings show that circulating hs-cTnT/I are frequently, though not uniformly, elevated in newly diagnosed CS and that abnormally high values decrease rapidly in response to steroid therapy. Furthermore, elevated hs-cTnT/I concentrations associate with LV dysfunction and may predict poorer outcome although this still needs verification. These novel data suggest that hs-cTnT/I may provide a useful tool for the evaluation and care of CS.

The key stimulus to our work was the idea that

Acknowledgments

We want to thank the medical and nursing staff of the Division of Cardiology, Heart and Lung Center, Helsinki University Hospital, for help and support during this study.

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This work was supported by the Finnish government grant for medical research, Finnish Foundation for Cardiovascular Research, and Finnish Cultural Foundation, Helsinki, Finland.

See page 964 for disclosure information.

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