Using Serum Troponins to Screen for Cardiac Involvement and Assess Disease Activity in the Idiopathic Inflammatory Myopathies

Objectives
Limitations in the methods available for identifying cardiac involvement and accurately quantifying disease activity in the idiopathic inflammatory myopathies (IIM) may contribute to poor outcomes.
We investigated the utility of different serum muscle damage markers (total creatine kinase [CK], cardiac troponin T [cTnT] and cardiac troponin I [cTnI]) to address these issues.
Methods
We assessed disease activity and cardiac involvement using the International Myositis Assessment and Clinical Studies Group (IMACS) core set measures in 123 participants with confirmed adult-onset-IIM from the UK and Denmark. Total CK, cTnT and cTnI were measured. Associations were assessed using logistic regression and Spearman’s ranked correlation.
Results
Cardiac involvement (n=18) was associated with higher cTnI levels, independent of overall disease activity (adjusted OR 1.03, 95%CI 1.01-1.05, p=0.002). An abnormal cTnI had the highest specificity and positive predictive value for cardiac involvement (95% and 62% respectively).
In those with a normal CK, but raised cTnT or cTnI, an association with increased disease activity scores was observed. Serum cTnT correlated with the physician (rho 0.39) and patient-assessed (rho 0.28) global visual analogue scales and Health Assessment Questionnaire (rho 0.41) more strongly than CK or cTnI levels. cTnT was the only marker to correlate with manual muscle testing scores (rho -0.24).
Conclusions
Serum cTnI testing may have a role in screening for cardiac involvement in IIM. Abnormal levels of serum cTnT and cTnI are associated with increased disease activity, including in those with a normal CK.