N‐terminal pro‐B‐type natriuretic peptide and high‐sensitivity troponin T hold diagnostic value in cardiac amyloidosis
Aims Cardiac amyloidosis (CA) is associated with an elevation of natriuretic peptides and troponins, predicting outcome. Nevertheless, the diagnostic yield of these biomarkers has not been extensively investigated. This study aimed to evaluate the diagnostic performance for CA of N‐terminal pro‐B‐ty...
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| Veröffentlicht in: | European journal of heart failure 2023-03, Vol.25 (3), p.335-346 |
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| creator | Vergaro, Giuseppe Castiglione, Vincenzo Aimo, Alberto Prontera, Concetta Masotti, Silvia Musetti, Veronica Nicol, Martin Cohen Solal, Alain Logeart, Damien Georgiopoulos, Georgios Chubuchny, Vladyslav Giannoni, Alberto Clerico, Aldo Buda, Gabriele Patel, Kiara N. Razvi, Yousuf Patel, Rishi Wechalekar, Ashutosh Lachmann, Helen Hawkins, Philip N. Passino, Claudio Gillmore, Julian Emdin, Michele Fontana, Marianna |
| description | Aims
Cardiac amyloidosis (CA) is associated with an elevation of natriuretic peptides and troponins, predicting outcome. Nevertheless, the diagnostic yield of these biomarkers has not been extensively investigated. This study aimed to evaluate the diagnostic performance for CA of N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP) and high‐sensitivity troponin T (hs‐TnT).
Methods and results
Patients with suspected CA (n = 1149) underwent a diagnostic work‐up in three centres in Italy, France (n = 343, derivation cohort), and United Kingdom (n = 806, validation cohort). Biomarker values with either 100% sensitivity or ≥95% specificity were selected as rule‐out/rule‐in cut‐offs, respectively. In the derivation cohort, 227 patients (66%) had CA, and presented with higher NT‐proBNP and hs‐TnT. NT‐proBNP 180 ng/L and hs‐TnT 14 ng/L were selected as rule‐out cut‐offs, and hs‐TnT 86 ng/L as rule‐in cut‐off. NT‐proBNP |
| doi_str_mv | 10.1002/ejhf.2769 |
| format | Article |
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Cardiac amyloidosis (CA) is associated with an elevation of natriuretic peptides and troponins, predicting outcome. Nevertheless, the diagnostic yield of these biomarkers has not been extensively investigated. This study aimed to evaluate the diagnostic performance for CA of N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP) and high‐sensitivity troponin T (hs‐TnT).
Methods and results
Patients with suspected CA (n = 1149) underwent a diagnostic work‐up in three centres in Italy, France (n = 343, derivation cohort), and United Kingdom (n = 806, validation cohort). Biomarker values with either 100% sensitivity or ≥95% specificity were selected as rule‐out/rule‐in cut‐offs, respectively. In the derivation cohort, 227 patients (66%) had CA, and presented with higher NT‐proBNP and hs‐TnT. NT‐proBNP 180 ng/L and hs‐TnT 14 ng/L were selected as rule‐out cut‐offs, and hs‐TnT 86 ng/L as rule‐in cut‐off. NT‐proBNP <180 ng/L or hs‐TnT <14 ng/L were found in 7% of patients, and ruled out CA without false negatives. In the validation cohort, 20% of patients (2% false negatives) had NT‐proBNP <180 ng/L or hs‐TnT <14 ng/L, and 10% showed both biomarkers below cut‐offs (0.5% false negatives). These cut‐offs refined CA prediction when added to echocardiographic scores in patients with a haematologic disease or an increased wall thickness. In the validation cohort, the 86 ng/L hs‐TnT cut‐off ruled in 20% of patients (2% false positives). NT‐proBNP and hs‐TnT cut‐offs retained their rule‐out and rule‐in performance also in cohorts with CA prevalence of 20%, 10%, 5% and 1% derived from the original cohort through bootstrap analysis.
Conclusions
Cardiac biomarkers can refine the diagnostic algorithm in patients with suspected CA. NT‐proBNP <180 ng/L and hs‐TnT <14 ng/L reliably exclude the diagnosis, both in the overall population and subgroups referred for either AL‐CA or cardiac (pseudo)hypertrophy.
Cardiac biomarkers hold diagnostic value in cardiac amyloidosis (CA). The diagnosis can be reliably excluded when N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP) is <180 ng/L and high‐sensitivity troponin T (hs‐TnT) is <14 ng/L.]]></description><identifier>ISSN: 1388-9842</identifier><identifier>EISSN: 1879-0844</identifier><identifier>DOI: 10.1002/ejhf.2769</identifier><identifier>PMID: 36597836</identifier><language>eng</language><publisher>Oxford, UK: John Wiley & Sons, Ltd</publisher><subject>Amyloidosis - diagnosis ; Biomarkers ; Cardiac amyloidosis ; Diagnosis ; Heart Failure - diagnosis ; Humans ; Natriuretic Peptide, Brain ; NT‐proBNP ; Peptide Fragments ; Prognosis ; Troponin ; Troponin T</subject><ispartof>European journal of heart failure, 2023-03, Vol.25 (3), p.335-346</ispartof><rights>2023 European Society of Cardiology.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fejhf.2769$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fejhf.2769$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,1427,27901,27902,45550,45551,46384,46808</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36597836$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Vergaro, Giuseppe</creatorcontrib><creatorcontrib>Castiglione, Vincenzo</creatorcontrib><creatorcontrib>Aimo, Alberto</creatorcontrib><creatorcontrib>Prontera, Concetta</creatorcontrib><creatorcontrib>Masotti, Silvia</creatorcontrib><creatorcontrib>Musetti, Veronica</creatorcontrib><creatorcontrib>Nicol, Martin</creatorcontrib><creatorcontrib>Cohen Solal, Alain</creatorcontrib><creatorcontrib>Logeart, Damien</creatorcontrib><creatorcontrib>Georgiopoulos, Georgios</creatorcontrib><creatorcontrib>Chubuchny, Vladyslav</creatorcontrib><creatorcontrib>Giannoni, Alberto</creatorcontrib><creatorcontrib>Clerico, Aldo</creatorcontrib><creatorcontrib>Buda, Gabriele</creatorcontrib><creatorcontrib>Patel, Kiara N.</creatorcontrib><creatorcontrib>Razvi, Yousuf</creatorcontrib><creatorcontrib>Patel, Rishi</creatorcontrib><creatorcontrib>Wechalekar, Ashutosh</creatorcontrib><creatorcontrib>Lachmann, Helen</creatorcontrib><creatorcontrib>Hawkins, Philip N.</creatorcontrib><creatorcontrib>Passino, Claudio</creatorcontrib><creatorcontrib>Gillmore, Julian</creatorcontrib><creatorcontrib>Emdin, Michele</creatorcontrib><creatorcontrib>Fontana, Marianna</creatorcontrib><title>N‐terminal pro‐B‐type natriuretic peptide and high‐sensitivity troponin T hold diagnostic value in cardiac amyloidosis</title><title>European journal of heart failure</title><addtitle>Eur J Heart Fail</addtitle><description><![CDATA[Aims
Cardiac amyloidosis (CA) is associated with an elevation of natriuretic peptides and troponins, predicting outcome. Nevertheless, the diagnostic yield of these biomarkers has not been extensively investigated. This study aimed to evaluate the diagnostic performance for CA of N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP) and high‐sensitivity troponin T (hs‐TnT).
Methods and results
Patients with suspected CA (n = 1149) underwent a diagnostic work‐up in three centres in Italy, France (n = 343, derivation cohort), and United Kingdom (n = 806, validation cohort). Biomarker values with either 100% sensitivity or ≥95% specificity were selected as rule‐out/rule‐in cut‐offs, respectively. In the derivation cohort, 227 patients (66%) had CA, and presented with higher NT‐proBNP and hs‐TnT. NT‐proBNP 180 ng/L and hs‐TnT 14 ng/L were selected as rule‐out cut‐offs, and hs‐TnT 86 ng/L as rule‐in cut‐off. NT‐proBNP <180 ng/L or hs‐TnT <14 ng/L were found in 7% of patients, and ruled out CA without false negatives. In the validation cohort, 20% of patients (2% false negatives) had NT‐proBNP <180 ng/L or hs‐TnT <14 ng/L, and 10% showed both biomarkers below cut‐offs (0.5% false negatives). These cut‐offs refined CA prediction when added to echocardiographic scores in patients with a haematologic disease or an increased wall thickness. In the validation cohort, the 86 ng/L hs‐TnT cut‐off ruled in 20% of patients (2% false positives). NT‐proBNP and hs‐TnT cut‐offs retained their rule‐out and rule‐in performance also in cohorts with CA prevalence of 20%, 10%, 5% and 1% derived from the original cohort through bootstrap analysis.
Conclusions
Cardiac biomarkers can refine the diagnostic algorithm in patients with suspected CA. NT‐proBNP <180 ng/L and hs‐TnT <14 ng/L reliably exclude the diagnosis, both in the overall population and subgroups referred for either AL‐CA or cardiac (pseudo)hypertrophy.
Cardiac biomarkers hold diagnostic value in cardiac amyloidosis (CA). The diagnosis can be reliably excluded when N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP) is <180 ng/L and high‐sensitivity troponin T (hs‐TnT) is <14 ng/L.]]></description><subject>Amyloidosis - diagnosis</subject><subject>Biomarkers</subject><subject>Cardiac amyloidosis</subject><subject>Diagnosis</subject><subject>Heart Failure - diagnosis</subject><subject>Humans</subject><subject>Natriuretic Peptide, Brain</subject><subject>NT‐proBNP</subject><subject>Peptide Fragments</subject><subject>Prognosis</subject><subject>Troponin</subject><subject>Troponin T</subject><issn>1388-9842</issn><issn>1879-0844</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNo9kUtOwzAQhi0E4r3gAshLNmn9SBx7CQgoqIJNWUeD7bZGiRPipCgbxBE4IyfBEQVppHl9M9LMj9AZJRNKCJva1_VywnKhdtAhlblKiEzT3RhzKRMlU3aAjkJ4JYTmEd9HB1xkKpdcHKKPx-_Pr862lfNQ4qatY3o1lobGYg9d6_rWdk7jxjadMxaDN3jtVuvIBOuD69zGdQPu2rqpvfN4gdd1abBxsPJ1GCc3UPYWx5aGNpY1hmooa2fq4MIJ2ltCGezp1h-j59ubxfUsmT_d3V9fzpOGZVQl8TRqonEugKcv3AggGlKtlGRMS65yQYwQHCRkzGSGC2UyBVTnoElmCT9GF79744VvvQ1dUbmgbVmCt3Ufivg8IhkljEb0fIv2L5U1RdO6Ctqh-PtZBKa_wLsr7fDfp6QYxShGMcZ9qrh5mN2OAf8B_x-CFA</recordid><startdate>202303</startdate><enddate>202303</enddate><creator>Vergaro, Giuseppe</creator><creator>Castiglione, Vincenzo</creator><creator>Aimo, Alberto</creator><creator>Prontera, Concetta</creator><creator>Masotti, Silvia</creator><creator>Musetti, Veronica</creator><creator>Nicol, Martin</creator><creator>Cohen Solal, Alain</creator><creator>Logeart, Damien</creator><creator>Georgiopoulos, Georgios</creator><creator>Chubuchny, Vladyslav</creator><creator>Giannoni, Alberto</creator><creator>Clerico, Aldo</creator><creator>Buda, Gabriele</creator><creator>Patel, Kiara N.</creator><creator>Razvi, Yousuf</creator><creator>Patel, Rishi</creator><creator>Wechalekar, Ashutosh</creator><creator>Lachmann, Helen</creator><creator>Hawkins, Philip N.</creator><creator>Passino, Claudio</creator><creator>Gillmore, Julian</creator><creator>Emdin, Michele</creator><creator>Fontana, Marianna</creator><general>John Wiley & Sons, Ltd</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>7X8</scope></search><sort><creationdate>202303</creationdate><title>N‐terminal pro‐B‐type natriuretic peptide and high‐sensitivity troponin T hold diagnostic value in cardiac amyloidosis</title><author>Vergaro, Giuseppe ; Castiglione, Vincenzo ; Aimo, Alberto ; Prontera, Concetta ; Masotti, Silvia ; Musetti, Veronica ; Nicol, Martin ; Cohen Solal, Alain ; Logeart, Damien ; Georgiopoulos, Georgios ; Chubuchny, Vladyslav ; Giannoni, Alberto ; Clerico, Aldo ; Buda, Gabriele ; Patel, Kiara N. ; Razvi, Yousuf ; Patel, Rishi ; Wechalekar, Ashutosh ; Lachmann, Helen ; Hawkins, Philip N. ; Passino, Claudio ; Gillmore, Julian ; Emdin, Michele ; Fontana, Marianna</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-p2519-7691d91d336a34b3d6a0ca4c99822c839760d663a8a52d5d369d59a1c7ac05e03</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Amyloidosis - diagnosis</topic><topic>Biomarkers</topic><topic>Cardiac amyloidosis</topic><topic>Diagnosis</topic><topic>Heart Failure - diagnosis</topic><topic>Humans</topic><topic>Natriuretic Peptide, Brain</topic><topic>NT‐proBNP</topic><topic>Peptide Fragments</topic><topic>Prognosis</topic><topic>Troponin</topic><topic>Troponin T</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Vergaro, Giuseppe</creatorcontrib><creatorcontrib>Castiglione, Vincenzo</creatorcontrib><creatorcontrib>Aimo, Alberto</creatorcontrib><creatorcontrib>Prontera, Concetta</creatorcontrib><creatorcontrib>Masotti, Silvia</creatorcontrib><creatorcontrib>Musetti, Veronica</creatorcontrib><creatorcontrib>Nicol, Martin</creatorcontrib><creatorcontrib>Cohen Solal, Alain</creatorcontrib><creatorcontrib>Logeart, Damien</creatorcontrib><creatorcontrib>Georgiopoulos, Georgios</creatorcontrib><creatorcontrib>Chubuchny, Vladyslav</creatorcontrib><creatorcontrib>Giannoni, Alberto</creatorcontrib><creatorcontrib>Clerico, Aldo</creatorcontrib><creatorcontrib>Buda, Gabriele</creatorcontrib><creatorcontrib>Patel, Kiara N.</creatorcontrib><creatorcontrib>Razvi, Yousuf</creatorcontrib><creatorcontrib>Patel, Rishi</creatorcontrib><creatorcontrib>Wechalekar, Ashutosh</creatorcontrib><creatorcontrib>Lachmann, Helen</creatorcontrib><creatorcontrib>Hawkins, Philip N.</creatorcontrib><creatorcontrib>Passino, Claudio</creatorcontrib><creatorcontrib>Gillmore, Julian</creatorcontrib><creatorcontrib>Emdin, Michele</creatorcontrib><creatorcontrib>Fontana, Marianna</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>MEDLINE - Academic</collection><jtitle>European journal of heart failure</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Vergaro, Giuseppe</au><au>Castiglione, Vincenzo</au><au>Aimo, Alberto</au><au>Prontera, Concetta</au><au>Masotti, Silvia</au><au>Musetti, Veronica</au><au>Nicol, Martin</au><au>Cohen Solal, Alain</au><au>Logeart, Damien</au><au>Georgiopoulos, Georgios</au><au>Chubuchny, Vladyslav</au><au>Giannoni, Alberto</au><au>Clerico, Aldo</au><au>Buda, Gabriele</au><au>Patel, Kiara N.</au><au>Razvi, Yousuf</au><au>Patel, Rishi</au><au>Wechalekar, Ashutosh</au><au>Lachmann, Helen</au><au>Hawkins, Philip N.</au><au>Passino, Claudio</au><au>Gillmore, Julian</au><au>Emdin, Michele</au><au>Fontana, Marianna</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>N‐terminal pro‐B‐type natriuretic peptide and high‐sensitivity troponin T hold diagnostic value in cardiac amyloidosis</atitle><jtitle>European journal of heart failure</jtitle><addtitle>Eur J Heart Fail</addtitle><date>2023-03</date><risdate>2023</risdate><volume>25</volume><issue>3</issue><spage>335</spage><epage>346</epage><pages>335-346</pages><issn>1388-9842</issn><eissn>1879-0844</eissn><abstract><![CDATA[Aims
Cardiac amyloidosis (CA) is associated with an elevation of natriuretic peptides and troponins, predicting outcome. Nevertheless, the diagnostic yield of these biomarkers has not been extensively investigated. This study aimed to evaluate the diagnostic performance for CA of N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP) and high‐sensitivity troponin T (hs‐TnT).
Methods and results
Patients with suspected CA (n = 1149) underwent a diagnostic work‐up in three centres in Italy, France (n = 343, derivation cohort), and United Kingdom (n = 806, validation cohort). Biomarker values with either 100% sensitivity or ≥95% specificity were selected as rule‐out/rule‐in cut‐offs, respectively. In the derivation cohort, 227 patients (66%) had CA, and presented with higher NT‐proBNP and hs‐TnT. NT‐proBNP 180 ng/L and hs‐TnT 14 ng/L were selected as rule‐out cut‐offs, and hs‐TnT 86 ng/L as rule‐in cut‐off. NT‐proBNP <180 ng/L or hs‐TnT <14 ng/L were found in 7% of patients, and ruled out CA without false negatives. In the validation cohort, 20% of patients (2% false negatives) had NT‐proBNP <180 ng/L or hs‐TnT <14 ng/L, and 10% showed both biomarkers below cut‐offs (0.5% false negatives). These cut‐offs refined CA prediction when added to echocardiographic scores in patients with a haematologic disease or an increased wall thickness. In the validation cohort, the 86 ng/L hs‐TnT cut‐off ruled in 20% of patients (2% false positives). NT‐proBNP and hs‐TnT cut‐offs retained their rule‐out and rule‐in performance also in cohorts with CA prevalence of 20%, 10%, 5% and 1% derived from the original cohort through bootstrap analysis.
Conclusions
Cardiac biomarkers can refine the diagnostic algorithm in patients with suspected CA. NT‐proBNP <180 ng/L and hs‐TnT <14 ng/L reliably exclude the diagnosis, both in the overall population and subgroups referred for either AL‐CA or cardiac (pseudo)hypertrophy.
Cardiac biomarkers hold diagnostic value in cardiac amyloidosis (CA). The diagnosis can be reliably excluded when N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP) is <180 ng/L and high‐sensitivity troponin T (hs‐TnT) is <14 ng/L.]]></abstract><cop>Oxford, UK</cop><pub>John Wiley & Sons, Ltd</pub><pmid>36597836</pmid><doi>10.1002/ejhf.2769</doi><tpages>12</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1388-9842 |
| ispartof | European journal of heart failure, 2023-03, Vol.25 (3), p.335-346 |
| issn | 1388-9842 1879-0844 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2760821021 |
| source | Wiley Free Content; MEDLINE; Wiley Online Library Journals Frontfile Complete; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals |
| subjects | Amyloidosis - diagnosis Biomarkers Cardiac amyloidosis Diagnosis Heart Failure - diagnosis Humans Natriuretic Peptide, Brain NT‐proBNP Peptide Fragments Prognosis Troponin Troponin T |
| title | N‐terminal pro‐B‐type natriuretic peptide and high‐sensitivity troponin T hold diagnostic value in cardiac amyloidosis |
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