Serum cardiac troponins and N-terminal pro-brain natriuretic peptide

A staging system for primary systemic amyloidosis

Angela Dispenzieri, Morie Gertz, Robert A. Kyle, Martha Lacy, Mary F. Burritt, Terry M Therneau, Philip R. Greipp, Thomas Elmer Witzig, John A. Lust, S Vincent Rajkumar, Rafael Fonseca, Steven R. Zeldenrust, Christopher G A McGregor, Allan S Jaffe

Research output: Contribution to journalArticle

471 Citations (Scopus)

Abstract

Purpose: Primary systemic amyloidosis (AL) is a multisystemic disorder resulting from an underlying plasma cell dyscrasia. There is no formal staging system for AL, making comparisons between studies and treatment centers difficult. Our group previously identified elevated serum cardiac troponin T (cTnT) as the most powerful predictor of overall survival. Others have reported that N-terminal pro-brain natriuretic peptide (NT-proBNP) is a valuable prognostic marker. We sought to develop a staging system for patients with AL. Patients and Methods: Two hundred forty-two patients with newly diagnosed AL who were seen at the Mayo Clinic between April 1979 and November 2000, and who had echocardiograms and stored serum samples at presentation were eligible for this retrospective review. NT-proBNP measurements were performed on 242 patients in whom cTnT and cardiac troponin I (cTnI) had been previously run. Two prognostic models were designed using threshold values of NT-proBNP and either cTnT or cTnI (NT-proBNP < 332 ng/L, cTnT < 0.035 μg/L, and cTnI < 0.1 μg/L). Depending on whether NT-proBNP and troponin levels were both low, were high for only one level, or were both high, patients were classified as stage I, II, or III, respectively. Results: Using the cTnT+NT-proBNP model 33%, 30%, and 37% of patients were stages I, II, and III, respectively, with median survivals of 26.4, 10.5, and 3.5 months, respectively. The alternate cTnI+NT-proBNP model predicted median survivals of 27.2, 11.1, and 4.1 months, respectively. Conclusion: Stratification of AL patients into three stages is possible with two readily available and reproducible tests setting the stage for more consistent and reliable cross comparisons of therapeutic outcomes.

Original languageEnglish (US)
Pages (from-to)3751-3757
Number of pages7
JournalJournal of Clinical Oncology
Volume22
Issue number18
DOIs
StatePublished - 2004

Fingerprint

Troponin
Brain Natriuretic Peptide
Troponin T
Troponin I
Amyloidosis
Serum
Survival
Paraproteinemias
Primary amyloidosis
peptide A
Therapeutics

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Serum cardiac troponins and N-terminal pro-brain natriuretic peptide : A staging system for primary systemic amyloidosis. / Dispenzieri, Angela; Gertz, Morie; Kyle, Robert A.; Lacy, Martha; Burritt, Mary F.; Therneau, Terry M; Greipp, Philip R.; Witzig, Thomas Elmer; Lust, John A.; Rajkumar, S Vincent; Fonseca, Rafael; Zeldenrust, Steven R.; McGregor, Christopher G A; Jaffe, Allan S.

In: Journal of Clinical Oncology, Vol. 22, No. 18, 2004, p. 3751-3757.

Research output: Contribution to journalArticle

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abstract = "Purpose: Primary systemic amyloidosis (AL) is a multisystemic disorder resulting from an underlying plasma cell dyscrasia. There is no formal staging system for AL, making comparisons between studies and treatment centers difficult. Our group previously identified elevated serum cardiac troponin T (cTnT) as the most powerful predictor of overall survival. Others have reported that N-terminal pro-brain natriuretic peptide (NT-proBNP) is a valuable prognostic marker. We sought to develop a staging system for patients with AL. Patients and Methods: Two hundred forty-two patients with newly diagnosed AL who were seen at the Mayo Clinic between April 1979 and November 2000, and who had echocardiograms and stored serum samples at presentation were eligible for this retrospective review. NT-proBNP measurements were performed on 242 patients in whom cTnT and cardiac troponin I (cTnI) had been previously run. Two prognostic models were designed using threshold values of NT-proBNP and either cTnT or cTnI (NT-proBNP < 332 ng/L, cTnT < 0.035 μg/L, and cTnI < 0.1 μg/L). Depending on whether NT-proBNP and troponin levels were both low, were high for only one level, or were both high, patients were classified as stage I, II, or III, respectively. Results: Using the cTnT+NT-proBNP model 33{\%}, 30{\%}, and 37{\%} of patients were stages I, II, and III, respectively, with median survivals of 26.4, 10.5, and 3.5 months, respectively. The alternate cTnI+NT-proBNP model predicted median survivals of 27.2, 11.1, and 4.1 months, respectively. Conclusion: Stratification of AL patients into three stages is possible with two readily available and reproducible tests setting the stage for more consistent and reliable cross comparisons of therapeutic outcomes.",
author = "Angela Dispenzieri and Morie Gertz and Kyle, {Robert A.} and Martha Lacy and Burritt, {Mary F.} and Therneau, {Terry M} and Greipp, {Philip R.} and Witzig, {Thomas Elmer} and Lust, {John A.} and Rajkumar, {S Vincent} and Rafael Fonseca and Zeldenrust, {Steven R.} and McGregor, {Christopher G A} and Jaffe, {Allan S}",
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T1 - Serum cardiac troponins and N-terminal pro-brain natriuretic peptide

T2 - A staging system for primary systemic amyloidosis

AU - Dispenzieri, Angela

AU - Gertz, Morie

AU - Kyle, Robert A.

AU - Lacy, Martha

AU - Burritt, Mary F.

AU - Therneau, Terry M

AU - Greipp, Philip R.

AU - Witzig, Thomas Elmer

AU - Lust, John A.

AU - Rajkumar, S Vincent

AU - Fonseca, Rafael

AU - Zeldenrust, Steven R.

AU - McGregor, Christopher G A

AU - Jaffe, Allan S

PY - 2004

Y1 - 2004

N2 - Purpose: Primary systemic amyloidosis (AL) is a multisystemic disorder resulting from an underlying plasma cell dyscrasia. There is no formal staging system for AL, making comparisons between studies and treatment centers difficult. Our group previously identified elevated serum cardiac troponin T (cTnT) as the most powerful predictor of overall survival. Others have reported that N-terminal pro-brain natriuretic peptide (NT-proBNP) is a valuable prognostic marker. We sought to develop a staging system for patients with AL. Patients and Methods: Two hundred forty-two patients with newly diagnosed AL who were seen at the Mayo Clinic between April 1979 and November 2000, and who had echocardiograms and stored serum samples at presentation were eligible for this retrospective review. NT-proBNP measurements were performed on 242 patients in whom cTnT and cardiac troponin I (cTnI) had been previously run. Two prognostic models were designed using threshold values of NT-proBNP and either cTnT or cTnI (NT-proBNP < 332 ng/L, cTnT < 0.035 μg/L, and cTnI < 0.1 μg/L). Depending on whether NT-proBNP and troponin levels were both low, were high for only one level, or were both high, patients were classified as stage I, II, or III, respectively. Results: Using the cTnT+NT-proBNP model 33%, 30%, and 37% of patients were stages I, II, and III, respectively, with median survivals of 26.4, 10.5, and 3.5 months, respectively. The alternate cTnI+NT-proBNP model predicted median survivals of 27.2, 11.1, and 4.1 months, respectively. Conclusion: Stratification of AL patients into three stages is possible with two readily available and reproducible tests setting the stage for more consistent and reliable cross comparisons of therapeutic outcomes.

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