Chronic Troponin Elevation in HCM — EECC MCQ

Correct answer: A — Chronic myocardial injury from microvascular ischaemia (small vessel disease), myocardial fibrosis, and high intramyocardial wall stress in hypertrophied myocardium — chronically elevated troponin in HCM is an adverse prognostic marker

Chronic troponin elevation is found in 20-40% of HCM patients and reflects ongoing myocardial injury from: (1) microvascular ischaemia (intramural small vessel disease — arteriolar wall thickening, reduced capillary density relative to myocyte mass); (2) myocardial fibrosis (replacement and interstitial); (3) elevated intramyocardial wall stress; (4) apoptosis. Studies show that chronically elevated hs-cTn in HCM is independently associated with: higher SCD risk, greater LGE burden on CMR, development of systolic dysfunction, and adverse clinical outcomes. The 2023 ESC Cardiomyopathy Guidelines acknowledge troponin as a prognostic biomarker in HCM. Acute coronary syndrome should still be excluded when troponin rises acutely from baseline, but a stable chronically elevated level is characteristic of the disease itself.

Reference: ESC (2023): Cardiomyopathies Guidelines