Highlights
- •Subclinical heart involvement is common in Systemic Sclerosis.
- •Primary heart involvement portend a dismal prognosis.
- •hs-cTnT and NT-proBNP are biomarkers of early cardiac damage.
- •hs-cTnT and NT-proBNP are predictors of poor outcome.
- •hs-cTnT and NT-proBNP should be measured in all patients with Systemic Sclerosis.
Abstract
Objectives
The aim of our study was to define the role of high-sensitive cardiac troponin T (hs-cTnT)
and NT-proBNP in identifying Systemic Sclerosis (SSc) patients with cardiac involvement
and at higher risk of cardiac death.
Methods
Plasma hs-cTnT and NT-proBNP concentrations were measured in 245 SSc-patients.
Results
hs-cTnT and NT-proBNP levels were higher in SSc-patients than in healthy controls.
Hs-cTnT levels were higher than 0.014 ng/ml in 32.3% SSc-patients, while NT-proBNP
was above 125 pg/ml in 31.8% of them, irrespective of classical cardiovascular risk
factor and of pulmonary arterial hypertension. Elevated hs-cTnT and NT-proBNP were
associated with diffuse skin involvement and directly correlated with the skin score.
Patients with increased cardiac markers presented a lower left-ventricular ejection
fraction (LVEF) and a higher rate of right bundle branch block (RBBB) on electrocardiogram
(ECG) compared to patients with normal cardiac enzymes.
During the follow-up, 12 SSc-patients experience a disease-related death; 9 of these
were directly related to cardiac involvement (sudden cardiac death or heart failure)
and the majority of them occurred among patients with increase of at least one cardiac
biomarker. Long-term survival was worse in patients with increase of both cardiac
biomarkers.
Conclusions
Evaluation of hs-cTnT and NT-proBNP levels may provide a tool to screen non-invasively
SSc-patients for heart involvement. A higher incidence of impaired systolic function,
ECG abnormalities and a poor outcome in SSc-patients with elevated cardiac enzymes
suggests that they may be valuable screening biomarkers to detect a cardiac damage
at early stages and to improve risk stratification.
Keywords
Abbreviations:
SSc (Systemic Sclerosis), cTnT (cardiac troponin T), hs (high sensitive), LVEF (left ventricular ejection fraction), ECG (electrocardiogram), NT-proBNP (N-terminal of the prohormone brain natriuretic peptide), PAH (pulmonary)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: October 23, 2018
Accepted:
October 16,
2018
Received in revised form:
August 27,
2018
Received:
May 20,
2018
Identification
Copyright
© 2018 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
