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High sensitivity cardiac troponin T in patients with immunoglobulin light chain amyloidosis
  1. A Dispenzieri1,
  2. M A Gertz1,
  3. S K Kumar1,
  4. M Q Lacy1,
  5. R A Kyle1,
  6. A K Saenger2,
  7. M Grogan3,
  8. S R Zeldenrust1,
  9. S R Hayman1,
  10. F Buadi1,
  11. P R Greipp1,
  12. N Leung4,
  13. S R Russell5,
  14. D Dingli1,
  15. J A Lust1,
  16. S V Rajkumar1,
  17. A S Jaffe2,3
  1. 1Division of Hematology and Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
  2. 2The Division of Clinical Core Laboratory Services, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
  3. 3The Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
  4. 4Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
  5. 5Division of Molecular Medicine, Mayo Clinic, Rochester, Minnesota, USA
  1. Correspondence to Dr Allan S Jaffe, The Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Gonda 5, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA; Jaffe.Allan{at}Mayo.edu

Abstract

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 hs-cTnT 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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