• Seiji Takashio, Megumi Yamamuro, Yasuhiro Izumiya, Seigo Sugiyama, Sunao Kojima, Eiichiro Yamamoto, Kenichi Tsujita, Tomoko Tanaka, Shinji Tayama, Koichi Kaikita, Seiji Hokimoto, and Hisao Ogawa.
• Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
• J. Am. Coll. Cardiol. 2013 Aug 13; 62 (7): 632-40.

ObjectivesThis study investigated factors associated with cardiac troponin T (cTnT) release from failing myocardium.BackgroundPersistent and modest elevation of serum cTnT is frequently observed in heart failure (HF) patients free of coronary artery disease, although the mechanisms underlying this finding remain unclear.MethodsWe evaluated serum cTnT levels in the aortic root (Ao) and coronary sinus (CS) using a highly sensitive assay in 90 nonischemic HF patients and 47 non-HF patients. Transcardiac cTnT and plasma B-type natriuretic peptide (BNP) release were described as the differences between CS and Ao cTnT levels [ΔcTnT (CS-Ao)] and BNP levels [ΔBNP (CS-Ao)], respectively. Coronary flow reserve (CFR) was measured in 68 HF patients using an intracoronary Doppler guidewire.ResultsΔcTnT (CS-Ao) levels were available in 76 HF patients and 28 non-HF patients (84% vs. 60%; p = 0.001), and higher in HF patients than non-HF patients (p < 0.001). Among HF patients, log[ΔcTnT (CS-Ao)] correlated with log[ΔBNP (CS-Ao)] (r = 0.368, p = 0.001), pulmonary capillary wedge pressure (r = 0.253, p = 0.03) and left ventricular end-diastolic pressure (LVEDP) (r = 0.321, p = 0.005). Multivariate regression analysis identified LVEDP as an independent parameter that correlated with ΔcTnT (CS-Ao). ΔcTnT (CS-Ao) levels were available in 58 HF patients who were evaluated for CFR. Coronary microvascular dysfunction, diagnosed by CFR <2.0, was observed in 18 HF patients. ΔcTnT (CS-Ao) was higher in patients with coronary microvascular dysfunction (4.8 [2.0 to 8.1] ng/l) than those without (2.0 [1.2 to 4.6] ng/l; p = 0.04).ConclusionscTnT release from failing myocardium correlated with diastolic load and coronary microvascular dysfunction in nonischemic HF patients.Copyright © 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

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