Cardiac troponin T vs other biochemical markers in patients with congestive heart failure
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Published on: August 8, 2013
Yukiko Nishio1, Yukihito Sato, Ryoji Taniguchi
1Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.
Insights
Elevated cardiac troponin T (cTnT) indicates ongoing myocardial injury and is linked to worse outcomes in congestive heart failure (CHF). High cTnT levels correlate with markers of cardiac fibrosis, inflammation, and metabolic issues, predicting higher rehospitalization rates.
Area of Science:
- Cardiology
- Biochemistry
- Internal Medicine
Background:
- Myocardial injury can lead to cardiac remodeling and congestive heart failure (CHF).
- Cardiac troponin T (cTnT) is a sensitive marker of myocardial injury and a predictor of long-term outcomes in CHF patients.
Purpose of the Study:
- To investigate the relationship between serum cTnT levels and other biochemical markers in patients with CHF.
- To identify predictors of death or rehospitalization for CHF.
Main Methods:
- 145 hospitalized CHF patients were divided into low (<0.01 ng/ml) and high (>=0.01 ng/ml) serum cTnT groups.
- Correlations between cTnT and markers like BNP, ICTP, PIIIP, renin, NOREPI, CRP, cholesterol, Hb, uric acid, and HbA1c were examined.
- Predictive values for death or rehospitalization were assessed using univariate and multivariate analyses.
Main Results:
- Patients with high cTnT showed elevated BNP, ICTP, PIIIP, NOREPI, CRP, uric acid, and HbA1c.
- Conversely, high cTnT patients had lower cholesterol and hemoglobin levels.
- High cTnT was associated with a significantly higher rate of death or rehospitalization for CHF (41% vs 9%).
Conclusions:
- Ongoing myocardial injury, indicated by high cTnT, is associated with sympathetic system activation, cardiac fibrosis, inflammation, and metabolic abnormalities in CHF patients.
- High cTnT and elevated renin levels were identified as significant independent predictors of adverse outcomes in CHF.
Background:
Several pathologic processes can cause myocardial injury, which is followed by cardiac remodeling and congestive heart failure (CHF). Cardiac troponin T (cTnT), a specific and sensitive marker of myocardial injury, has been related to long-term outcome in patients with CHF, so the relationship between cTnT and other biochemical markers associated with the pathophysiology of CHF was investigated in the present study.
Methods And Results:
Between February 2004 and December 2005, 145 consecutive hospitalized patients (mean left ventricular ejection fraction (LVEF) 31.6+/-0.9%) with CHF were divided into low (<0.01 ng/ml) and high (> or =0.01 ng/ml) serum cTnT groups. Correlations with other prognostic biochemical markers, including brain natriuretic peptide (BNP), type I collagen C-terminal telopeptide (ICTP), procollagen type III peptide (PIIIP), renin, norepinephrine (NOREPI), C-reactive protein (CRP), cholesterol, hemoglobin (Hb), uric acid and HbA1c were examined. cTnT was high in 46 (32%) and low in 99 (68%) patients at baseline. Patients with high cTnT had abnormally high blood concentrations of BNP (p<0.0001), ICTP (p<0.0001), PIIIP (p=0.0006), NOREPI (p=0.0119), CRP (p=0.0003), uric acid (p=0.0026) and HbA1c (p=0.0361). In contrast, concentrations of cholesterol and Hb were significantly lower in patients with high cTnT (p=0.0319 and 0.0005, respectively). Death from or rehospitalization for CHF occurred in 41% in the high vs 9% in the low cTnT group (p=0.0002). Univariate analysis showed that high cTnT (p=0.0005), BNP (p=0.0001), renin (p=0.0158), NOREPI (p=0.0094), old age (p=0.0390), low LVEF (p=0.0231) and high New York Heart Association (NYHA) class (p=0.0006) were predictors of death from or rehospitalization for CHF. By multivariate analysis including BNP, NOREPI, age, LVEF and NYHA class, high cTnT and renin remained as significant predictors.
Conclusions:
Patients with ongoing myocardial injury and high cTnT had associated findings consistent with activation of the sympathetic system, synthesis of cardiac fibrosis, inflammation and metabolic abnormalities. By multivariate analysis, high cTnT and renin remained significant predictors of death or rehospitalization.
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