Higth-sensitivity T troponin and NT pro B-type natriuretic peptide as predictors of early development of structural heart disease in patients with stage 0 of Chagas disease
Authors: Chirino D , Vitale F , Leonardi M , Toledo G , Volverg V , Dizeo C , Calderon G 
Published: October 2021

Abstract

Background
Approximately 30% of patients with Chagas disease (ChD) develop structural heart disease at some point in their evolution. There is an asymptomatic period where there is no evidence of cardiac involvement, called stage 0. Prognostic evaluation in this group of patients remains a challenge. On the other hand, the presence of elevated hight-sensitivity T troponin (HS-TnT) and N-terminal pro B-type natriuretic peptide (NT-proBNP) has been documented in the early stages of the ChD. The role of these biomarkers as predictors of early development of structural heart disease in the follow-up of stage 0 ChD has been poorly studied.

Purpose
The aim of this study is to evaluate if HS-TnT and NT-proBNP are a predictor of early development of cardiac structural alterations in the follow up of patients with stage 0 ChD.

Materials and methods
Outpatients with stage 0 of ChD (positive serology, with normal electrocardiogram, 24-hours holter and echocardiogram) were included prospectively. Baseline measurement of HS-TnT and NT-proBNP was performed. The follow-up was carried out with serial echocardiography and 24-hour Holter. The end point of development of structural heart disease was considered, defined as one of the following: left ventricular dilation (diastolic diameter of left ventricle &gt;60 mm in men or &gt;55 mm in women), deterioration of ventricular function (Drop &gt;10 points of Left Ventricular Ejection Fraction (LVEF) or LVEF &lt;50%), Complex ventricular arrhythmia or Atrio-ventricular block ≥ second degree Mobitz II. Univariate and multivariate analysis was performed by cox regression.

Results
Three hundred two patients were included, with 47±9 years old, 46% woman. With a median of follow-up of 34 (interquartile range 19 – 43) months, the end point of development of structural heart disease was presented in 4.6% (n=14 patients). In multivariate analysis both HS-TnT and NT-ProBNP were independent predictors of development of structural heart disease [HR 1.18 (IC95% 1.05–1.33), p=0.003 and HR 1.01 (CI95% 1.00–1.01), p=0.001; respectively]. The area under the Receiver operating characteristic (ROC) curve was calculated, for HS-TnT it was 0.80 (95% CI 0.65–0.93), with a cut-off point for HS-TnT &gt;14 ng/ml and for NT-proBNP it was 0.88 (95% CI 0.83–0.95) with a cut-off point for NT-proBNP &gt;200 pg/ml. The figure shows the Kaplan-Meier curve for HS-TnT and NT-proBNP. In adjusted analysis, HS-TnT &gt;14 ng/ml had a HR 5.27 (CI95% 1.4–18.9), p=0.01 and NT-proBNP HR 3.07 (CI95% 1.01–10.9), P=0.04.

Conclusions
In our population of patients with stage 0 chagas disease, HS-TnT and NT-proBNP were independent predictors of early development of structural heart disease, with good predictive capacity. The baseline measurement of these biomarkers can be useful in the evaluation and follow-up of patients with ChD without initial evidence of cardiac involvement.

Funding Acknowledgement
Type of funding sources: None. Kaplan-Meier curve