Dynamics of high-sensitivity cardiac troponin T during therapy with balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension

Abstract

Aims Balloon pulmonary angioplasty (BPA) is an interventional treatment modality for inoperable chronic thromboembolic pulmonary hypertension (CTEPH). Therapy monitoring, based on non-invasive biomarkers, is a clinical challenge. This post-hoc study aimed to assess dynamics of high-sensitivity cardiac troponin T (hs-cTnT) as a marker for myocardial damage and its relation to N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels as a marker for cardiac wall stress. Methods and results This study included 51 consecutive patients who underwent BPA treatment and completed a 6-month follow-up (6-MFU) between 3/2014 and 3/2017. Biomarker measurement was performed consecutively prior to each BPA and at 6-MFU. In total, the 51 patients underwent an average of 5 BPA procedures. The 6-month survival rate was 96.1%. The baseline (BL) meanPAP (39.5±12.1mmHg) and PVR (515.8 ±219.2dyn×sec×cm -5 ) decreased significantly within the 6-MFU (meanPAP: 32.6 ±12.6mmHg, P<0.001; PVR: 396.9±182.6dyn×sec×cm -5 , P<0.001). At BL, the median hscTnT level was 11 (IQR 6±16) ng/L and the median NT-proBNP level was 820 (IQR 153± 1872) ng/L. The levels of both biomarkers decreased steadily after every BPA, showing the first significant difference after the first procedure. Within the 6-MFU, hs-cTnT levels (7 [IQR 5±12] ng/L; P<0.001) and NT-proBNP levels (159 [IQR 84±464] ng/l; P<0.001) continued to decrease. The hs-cTnT levels correlated with the PVR (r rs = 0.42; p = 0.005), the meanPAP (r rs = 0.32; p = 0.029) and the NT-proBNP (r rs = 0.51; p<0.001) levels at BL. Conclusion Non-invasive biomarker measurement provides valuable evidence for the decreasing impairment of myocardial function and structure during BPA therapy. Changes in hs-cTNT levels are suggestive for a reduction in ongoing myocardial damage.