Impact of beta blocker and angiotensin converting enzyme inhibitor/angiotensin II receptor blocker on prognosis of apical hypertrophic cardiomyopathy

The usefulness of prolonged troponin-T (TnT) monitoring in outpatients with nonischemic heart failure (HF) is not clear. The aim of this study was to investigate the incidence, prognostic value, and determinants of a raised TnT level.The study involved 80 outpatients (age 56[14] years, 69% male) with chronic stable HF (mean left ventricular ejection fraction, 24[9]; 51 in New York Heart Association class II and 29 in class III) of non-ischemic origin, as confirmed with coronary angiography. The TnT level was measured at study entry and at every outpatient visit (median interval, 3.1 months; interquartile range [IQR], 1.8-5.0 months) in a follow-up period of 22.2(10.6) months. Patients were TnT+ if the level was measurable (ie, >0.01 ng/mL).At study entry, 7 (9%) patients were TnT+. By 5 years, the cumulative incidence had reached 53%, and the median TnT level was 0.059 ng/mL (IQR, 0.023-0.100 ng/mL; range, 0.013-0.500 ng/mL). Beta-blocker therapy was associated with a reduction in incidence (hazard ratio [HR]=0.220; 95% confidence interval [CI], 0.089-0.540; P =.001) while the incidence increased with the N-terminal probrain natriuretic peptide (NT-proBNP) level (HR=1.005; 95% CI, 1.001-1.010; P =0.021). During follow-up, 14 (17.5%) patients had a cardiac event (ie, 9 cardiac deaths and 5 urgent transplants); these occurred in 12 (50%) of the 24 TnT+ patients versus 2 (3.6%) of the 56 TnT– patients (P 0,01 ng/ml).En la visita inicial 7 (9%) pacientes presentaban TnT+, y la incidencia acumulada a 5 años alcanzó el 53%, con una mediana de 0,059 (intervalo inter-cuartílico, 0,023-0,1; mínimo, 0,013; máximo, 0,5) ng/ml. La incidencia de TnT+ estuvo disminuida en caso de tratamiento con bloqueadores beta (hazard ratio [HR] = 0,220; intervalo de confianza [IC] del 95%, 0,089-0,540; p = 0,001) y aumentada en relación con el nivel de NT-proBNP (HR = 1,005; IC del 95%, 1,001-1,010; p = 0,021). Presentaron eventos durante el seguimiento 14 (17,5%) pacientes (9 muertes cardiacas y 5 trasplantes urgentes), que ocurrieron en 12 (50%) de 24 con TnT+ frente a 2 (3,6%) de 56 con TnT1– (p < 0,001). Tras el ajuste multivariable de Cox, la aparición de TnT+ fue predictora de eventos adversos (0,01 ng/ml: HR = 1,359; IC del 95%, 1,037-1,782; p = 0,026) con independencia delEn el seguimiento ambulatorio de pacientes con insuficiencia cardiaca no isquémica, la aparición de TnT+ es frecuente e identifica un peor pronóstico, incluso con bajas concentraciones.