Elevated troponin T on discharge predicts poor outcome of decompensated heart failure

Area of Science:

• Cardiology
• Biomarkers
• Heart Failure Pathophysiology

Background:

• Persistent elevation of cardiac troponin T (cTnT) is linked to poor prognosis in chronic heart failure (HF).
• The mechanisms connecting predischarge cTnT levels to underlying pathophysiology in decompensated HF require further investigation.

Purpose of the Study:

• To explore the association between elevated predischarge cTnT levels and specific pathophysiological factors in patients hospitalized for decompensated HF.
• To determine if predischarge cTnT elevation independently predicts adverse clinical outcomes after hospital discharge.

Main Methods:

• A cohort of 170 patients with decompensated HF had plasma cTnT levels measured before discharge.
• Patients were stratified into cTnT-positive (n=40) and cTnT-negative (n=130) groups.
• Multivariate and Cox proportional hazards analyses were used to identify predictors of cTnT positivity and mortality.

Main Results:

• Predischarge cTnT elevation was independently associated with lack of beta-blocker use, elevated high-sensitivity C-reactive protein (hsCRP), high brain natriuretic peptide (BNP), diabetes, and anemia.
• The cTnT-positive group experienced significantly higher rates of total mortality, cardiac death, and HF exacerbations requiring hospitalization.
• cTnT positivity was an independent predictor of mortality (HR=5.008, P=0.004) in a matched model.

Conclusions:

• Elevated predischarge cTnT in decompensated HF patients reflects significant underlying pathophysiology, including inflammation and neurohormonal activation.
• cTnT elevation identifies patients at high risk for adverse outcomes, including mortality and rehospitalization.
• Optimizing medical therapy, such as beta-blocker use, and managing comorbidities like diabetes and anemia may be crucial in patients with elevated cTnT.