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Original article
High T2-weighted signal intensity is associated with elevated troponin T in hypertrophic cardiomyopathy
  1. DH Frank Gommans1,
  2. G Etienne Cramer1,
  3. Jeannette Bakker2,
  4. Michelle Michels3,
  5. Hendrik-Jan Dieker1,
  6. Janneke Timmermans1,
  7. Michael A Fouraux4,
  8. Carlo LM Marcelis5,
  9. Freek WA Verheugt1,
  10. Marc A Brouwer1,
  11. Marcel JM Kofflard6
  1. 1Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
  2. 2Department of Radiology, Albert Schweitzer Hospital, Dordrecht, The Netherlands
  3. 3Department of Cardiology, Erasmus Medical Centre, Rotterdam, The Netherlands
  4. 4Department of Clinical Chemistry, Albert Schweitzer Hospital, Dordrecht, The Netherlands
  5. 5Department of Clinical Genetics, Radboud University Medical Centre, Nijmegen, The Netherlands
  6. 6Department of Cardiology, Albert Schweitzer Hospital, Dordrecht, The Netherlands
  1. Correspondence to DH Frank Gommans, Department of Cardiology, Radboud University Medical Centre, 616, Geert Grooteplein 10, P.O. Box 9101, Nijmegen 6525 GA, The Netherlands; frank.gommans{at}


Objective Areas of high signal intensity (HighT2) on T2-weighted cardiovascular magnetic resonance (CMR) imaging have been demonstrated in hypertrophic cardiomyopathy (HCM). It has been hypothesised that HighT2 may indicate active tissue injury in HCM. In this context, we studied HighT2 in relation to cardiac troponin.

Methods Outpatient HCM patients without a history of coronary artery disease underwent CMR imaging at 1.5 T using T2-weighted, cine and late gadolinium enhancement (LGE) imaging to assess HighT2, left ventricular (LV) function, LV mass and the presence and extent of LGE. Highly sensitive cardiac troponin T (hs-cTnT) was assessed as a marker of injury, with hs-cTnT ≥14 and >3 ng/L defined as an elevated and detectable troponin.

Results HighT2 was present in 28% of patients (28/101). An elevated hs-cTnT was present in 54% of patients with HighT2 (15/28) compared with 14% of patients without HighT2 (10/73) (p<0.001). Hs-cTnT was detectable in 96% of patients with HighT2 (27/28) compared with 66% of patients without HighT2 (48/73) (p=0.002). In case of an undetectable hs-cTnT, HighT2 was only seen in 4% (1/26). In addition, the extent of HighT2 was related with increasing hs-cTnT concentrations (Spearman's ρ: 0.42, p<0.001).

Conclusions In this CMR study of patients with HCM, we observed HighT2 in a quarter of patients, and demonstrated that HighT2 was associated with an elevated hs-cTnT. This observation, combined with the very high negative predictive value of an undetectable hs-cTnT for HighT2, provides supportive evidence for the hypothesis that HighT2 is indicative of recently sustained myocyte injury.

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  • Contributors All authors analysed data, developed the study protocol and design and read, commented on, contributed to and approved the submitted manuscript. DHFG, GEC and MAB were the main contributors to the writing of the manuscript. MAB and MJMK contributed to the planning and interpretation of the study. Our manuscript is not under consideration elsewhere and has not been published previously.

  • Competing interests None declared.

  • Ethics approval METC Nijmegen.

  • Provenance and peer review Not commissioned; externally peer reviewed.