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. 2022 Jan:13:100115.
doi: 10.1016/j.ahjo.2022.100115. Epub 2022 Mar 3.

Ultra-high sensitivity cardiac troponin-I concentration and left ventricular structure and function in women with ischemia and no obstructive coronary artery disease

Odayme Quesada  1   2 , Omeed Elboudwarej  1 , Michael D Nelson  3 , Ahmed Al-Badri  1 , Mitra Mastali  4 , Janet Wei  1 , Bijan Zarrabi  1 , Nissi Suppogu  1 , Haider Aldiwani  1 , Puja Mehta  5 , Chrisandra Shufelt  1 , Galen Cook-Wiens  6 , Daniel S Berman  7 , Louise E J Thomson  7 , Eileen Handberg  8 , Carl J Pepine  8 , Jennifer E Van Eyk  4 , C Noel Bairey Merz  1
Affiliations

Ultra-high sensitivity cardiac troponin-I concentration and left ventricular structure and function in women with ischemia and no obstructive coronary artery disease

Odayme Quesada et al. Am Heart J Plus. 2022 Jan.

Abstract

Aims: Women are disproportionally impacted by ischemia and no obstructive coronary artery disease (INOCA), and such women are at increased risk of developing heart failure with preserved ejection fraction (HFpEF), however the mechanisms linking these conditions remain poorly understood. The aim of this study was to determine whether ultra-high sensitivity cardiac troponin I (u-hscTnI), an indicator of cardiomyocyte injury, is associated with abnormalities in myocardial perfusion and left ventricular (LV) structure and function in women with INOCA.

Methods: 327 women with INOCA enrolled in the Women's Ischemia Syndrome Evaluation-Coronary Vascular Dysfunction (WISE-CVD) study underwent vasodilator stress cardiac magnetic resonance imaging (CMRI) and u-hscTnI measurements (Simoa HD-1 Analyzer, Quanterix Corporation). Multivariable linear regression was used to evaluate associations between u-hscTnI concentrations and myocardial perfusion (MPRI), LV mass index and feature-tracking derived strain measures of LV function.

Results: u-hscTnI concentrations were quantifiable in 100% of the cohort and ranged from 0.004 to 79.6 pg/mL. In adjusted models, u-hscTnI was associated with LV mass index (+2.03; 95% CI 1.17, 2.89; p < 0.01) and early diastolic radial strain rate (SR) (+0.13; 95% CI 0.01, 0.25; p = 0.03), early diastolic circumferential SR (-0.04; 95% CI -0.08, 0.002; p = 0.06) and early diastolic longitudinal SR (-0.03; 95% CI -0.07, 0.002; p = 0.06). u-hscTnI was not associated with MPRI (p = 0.39) in adjusted models.

Conclusion: Together, these findings support cardiomyocyte injury as a putative pathway towards adverse LV remodeling and dysfunction; however, further research is needed to define the specific mechanism(s) driving myocellular injury in INOCA.

Keywords: Cardiomyocyte injury; Diastolic strain; Ischemia and no obstructive coronary artery disease (INOCA); Left ventricular dysfunction; Left ventricular mass; Ultra-high sensitivity cardiac troponin.

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Conflict of interest statement

Declaration of competing interest Dr. Bairey Merz serves as Board of Director for iRhythm, fees paid through CSMC from Abbott Diagnostics and Sanofi.

Figures

Fig. 1
Fig. 1
Strain rate maps and profiles. A. Longitudinal, radial and circumferential strain maps. B. Typical strain rate profiles across the cardiac cycle in a representative subject with elevated ultra-high sensitive cardiac troponin-I (u-hscTnI, red line, 5.61 pg/mL) and a representative subject with low u-hscTnI (green line, 0.13 pg/dL). Data are reported as a percentage of the cardiac cycle, beginning with systolic contraction (s'SR) and progressing to early and late diastole (e'SR and a'SR, respectively). C. Early longitudinal diastolic strain rate (eLSRd), early radial diastolic strain rate (eRSRd), and early circumferential diastolic strain rate (eCSRd) by tertiles of u-hscTnI concentration. Kruskal-Wallace p-value < 0.0001 for all. Central Illustration. Summary of the relation between ultra-high sensitive cardiac troponin-I (u-hscTnI) and left ventricular strain. (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)
See this image and copyright information in PMC

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