Cardiac troponin T for risk stratification in decompensated chronic heart failure
Carlos Henrique Del Carlo1, Antonio Carlos Pereira-Barretto, Célia Maria Cassaro-Strunz
1Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil. dcarlo@cardiol.br
Insights
Elevated cardiac troponin T (cTnT) levels in decompensated heart failure (HF) indicate a poor prognosis. Higher cTnT ranges are significantly associated with increased mortality and re-hospitalization risk.
Area of Science:
- Cardiology
- Biomarkers
- Heart Failure Research
Background:
- Cardiac troponins are sensitive and specific indicators of myocardial injury.
- Elevated cardiac troponins have been observed in heart failure (HF) patients, correlating with adverse outcomes.
Purpose of the Study:
- To investigate the association between cardiac troponin T (cTnT) levels and prognosis in patients with decompensated HF.
- To determine if specific ranges of cTnT can aid in risk stratification for HF patients.
Main Methods:
- A cohort of 70 patients hospitalized for chronic HF exacerbation was studied.
- Cox proportional hazards models were employed to identify predictors of a composite outcome (death or HF re-hospitalization) over a 1-year follow-up.
- Patients were stratified into low, intermediate, and high cTnT groups for prognostic analysis.
Main Results:
- Multivariate analysis identified elevated cTnT (≥0.100 ng/mL), larger left ventricular end-diastolic diameter (≥70 mm), and lower serum sodium (<135 mEq/L) as significant predictors of adverse events.
- Patients in the high cTnT group (≥0.100 ng/mL) had significantly lower survival (16.7%) and event-free survival (8.3%) probabilities compared to intermediate and low cTnT groups.
- A clear trend of decreasing survival and event-free survival was observed with increasing cTnT levels.
Conclusions:
- Increased cardiac troponin T levels are strongly associated with a poor prognosis in decompensated heart failure.
- The degree of cTnT elevation serves as a valuable tool for risk stratification in patients with acute HF exacerbations.
Background:
The cardiac troponins are highly sensitive and specific markers of myocardial injury. They have been detected in heart failure (HF) and are associated with a bad prognosis.
Objective:
To evaluate the association of cardiac troponin T (cTnT) and its ranges with prognosis in decompensated HF.
Methods:
A total of 70 patients with chronic HF worsening that needed hospitalization were studied. Cox model was used to evaluate the variables at admission capable of predicting the combined outcome that consisted of death or re-hospitalization due to HF worsening during a 1-year follow-up.
Results:
During the follow-up, there were 44 deaths, 36 re-hospitalizations due to HF and 56 combined outcomes. At the multivariate analysis, the predictors of clinical events were the cTnT (cTnT > or = 0.100 ng/mL; hazard ratio [HR] 3.95 95% confidence interval [CI]: 1.64-9.49, p = 0.002), left ventricular end diastolic diameter (LVDD > or = 70 mm; HR 1.92, 95%CI: 1.06-3.47, p = 0.031) and serum sodium (Na < 135 mEq/L; HR 1.79, 95%CI: 1.02-3.15, p = 0.044). To evaluate the association between the cTnT increase and the prognosis in decompensated HF, the patients were stratified in three groups: low-cTnT (cTnT <0.020 ng/ml, n = 22), intermediate-cTnT (cTnT > 0.020 and < 0.100 ng/ml, n = 36), and high-cTnT (cTnT > or = 0.100 ng/ml, n = 12).The probabilities of survival and event-free survival were 54.2%, 31.5%, 16.7% (p = 0.020) and 36.4%, 11.5%, 8.3% (p = 0.005), respectively.
Conclusion:
The increase in cTnT is associated with a bad prognosis in decompensated HF and the degree of this increase can help the risk stratification.
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