Cardiac troponin-I on diagnosis predicts early death and refractoriness in acquired thrombotic thrombocytopenic purpura. Experience of the French Thrombotic Microangiopathies Reference Center.

Abstract

BACKGROUND:

Cardiac involvement is a major cause of mortality in patients with thrombotic thrombocytopenic purpura (TTP). However, diagnosis remains underestimated and delayed, owing to subclinical injuries. Cardiac troponin-I measurement (cTnI) on admission could improve the early diagnosis of cardiac involvement and have prognostic value.

OBJECTIVES:

To assess the predictive value of cTnI in patients with TTP for death or refractoriness.

PATIENTS/METHODS:

The study involved a prospective cohort of adult TTP patients with acquired severe ADAMTS-13 deficiency (< 10%) and included in the registry of the French Reference Center for Thrombotic Microangiopathies. Centralized cTnI measurements were performed on frozen serum on admission.

RESULTS:

Between January 2003 and December 2011, 133 patients with TTP (mean age, 48 ± 17 years) had available cTnI measurements on admission. Thirty-two patients (24%) had clinical and/or electrocardiogram features. Nineteen (14.3%) had cardiac symptoms, mainly congestive heart failure and myocardial infarction. Electrocardiogram changes, mainly repolarization disorders, were present in 13 cases. An increased cTnI level (> 0.1 μg L(-1) ) was present in 78 patients (59%), of whom 46 (59%) had no clinical cardiac involvement. The main outcomes were death (25%) and refractoriness (17%). Age (P = 0.02) and cTnI level (P = 0.002) showed the greatest impact on survival. A cTnI level of > 0.25 μg L(-1) was the only independent factor in predicting death (odds ratio [OR] 2.87; 95% confidence interval [CI] 1.13-7.22; P = 0.024) and/or refractoriness (OR 3.03; 95% CI 1.27-7.3; P = 0.01).

CONCLUSIONS:

A CTnI level of > 0.25 μg L(-1) at presentation in patients with TTP appears to be an independent factor associated with a three-fold increase in the risk of death or refractoriness. Therefore, cTnI level should be considered as a prognostic indicator in patients diagnosed with TTP.

• Authors: Y Benhamou, P-Y Boelle, B Baudin, S Ederhy, J Gras, L Galicier, E Azoulay, F Provôt, E Maury, F Pène, J-P Mira, A Wynckel, C Presne, P Poullin, J-M Halimi, Y Delmas, T Kanouni, A Seguin, C Mousson, A Servais, D Bordessoule, P Perez, M Hamidou, A Cohen, A Veyradier, P Coppo, Reference Center for Thrombotic Microangiopathies
• Journal: Journal of thrombosis and haemostasis : JTH (J Thromb Haemost) Vol. 13 Issue 2 Pg. 293-302 (Feb 2015) ISSN: 1538-7836 [Electronic] England
• PMID: 25403270 (Publication Type: Evaluation Study, Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)
• Copyright: © 2014 International Society on Thrombosis and Haemostasis.

Chemical References

• Biomarkers
• Troponin I
• ADAM Proteins
• ADAMTS13 Protein
• ADAMTS13 protein, human

Topics

• ADAM Proteins (deficiency, genetics)
• ADAMTS13 Protein
• Adult
• Aged
• Biomarkers (blood)
• Chi-Square Distribution
• Electrocardiography
• Female
• France
• Heart Diseases (blood, diagnosis, etiology, mortality)
• Humans
• Logistic Models
• Male
• Middle Aged
• Multivariate Analysis
• Odds Ratio
• Predictive Value of Tests
• Prognosis
• Prospective Studies
• Purpura, Thrombotic Thrombocytopenic (blood, complications, diagnosis, genetics, mortality)
• Registries
• Risk Factors
• Time Factors
• Troponin I (blood)
• Up-Regulation