Impact of serial troponin release on outcomes in patients with acute heart failure: analysis from the PROTECT pilot
Christopher M O'Connor1, Mona Fiuzat, Carlo Lombardi
1Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA. oconn002@mc.duke.edu
Insights
Cardiac troponin T (cTnT) elevation is common in acute heart failure (AHF) and predicts outcomes. A significant percentage of AHF patients with initially normal cTnT developed elevated levels during hospitalization, indicating worse prognosis.
Area of Science:
- Cardiology
- Biomarkers
- Heart Failure Research
Background:
- Cardiac troponin T (cTnT) elevation is a known predictor of outcomes in acute heart failure (AHF).
- The dynamics and progression of cTnT release during AHF hospitalization require further clarification.
- This study investigates the incidence and prognostic significance of cTnT release in AHF patients.
Purpose of the Study:
- To evaluate the incidence of cTnT release during AHF hospitalization.
- To determine the relationship between cTnT release and patient outcomes.
- To assess the prognostic value of baseline and evolving cTnT levels in AHF.
Main Methods:
- Analysis of data from the PROTECT pilot study, a randomized, double-blind trial.
- Serial measurements of cTnT at baseline and on days 2, 3, 4, and 7.
- Classification of patients based on baseline cTnT levels: positive (>0.03 ng/mL), detectable (>0.01 ng/mL), and negative (≤0.01 ng/mL).
- Definition of cTnT conversion as a detectable level developing after baseline.
Main Results:
- 60% of AHF patients had detectable cTnT at baseline, with 34% having positive levels (>0.03 ng/mL).
- 21% of patients with negative baseline cTnT converted to detectable levels by day 7.
- Positive baseline cTnT was an independent predictor of 60-day cardiovascular/renal rehospitalization or death (HR, 1.84; P=0.036).
Conclusions:
- A high prevalence of baseline cTnT elevation exists in AHF patients.
- A notable proportion of patients initially negative for cTnT develop detectable levels during hospitalization.
- Both baseline positive cTnT and conversion to positive levels are associated with adverse 60-day outcomes.
Background:
Cardiac troponin T (cTnT) elevation is common and is a predictor of outcomes in patients with acute heart failure (AHF). The degree and progression of cTnT release during hospitalization of patients with AHF is unclear. We evaluated the incidence of cTnT release during AHF hospitalization and the relationship of cTnT release with outcomes.
Methods And Results:
The Placebo-controlled Randomized study of the selective A(1) adenosine receptor antagonist rolofylline for patients hospitalized with acute heart failure and volume Overload to assess Treatment Effect on Congestion and renal funcTion (PROTECT) pilot study was a multicenter, double-blind study of patients with AHF. Measurements of cTnT were collected at randomization and days 2, 3, 4, and 7. Patients were classified on the basis of their serum cTnT levels at baseline: positive (>0.03 ng/mL), detectable (>0.01 ng/mL), and negative (≤0.01 ng/mL). A detectable cTnT level developed during the study (after baseline) was classified as cTnT conversion: 288 patients were included; 172 (60%) patients had detectable cTnT levels and 97 (34%) had positive values (>0.03 ng/mL) at baseline. Of the 116 patients with negative troponin at baseline, 24 (21%) had elevated cTnT levels by day 7. On multivariable analysis, positive cTnT at baseline was an independent predictor of the composite end point of cardiovascular/renal rehospitalization or death at 60 days (hazard ratio, 1.84; 95% confidence interval, 1.04-3.26; P=0.036). Kaplan-Meier curves showed similar worse outcomes in patients with troponin conversion and positive troponin at baseline.
Conclusions:
There was a high prevalence of baseline cTnT elevation in this cohort; 21% of those negative at baseline converted to detectable levels by day 7. Positive troponin at baseline, and conversion to positive levels, were associated with worse outcomes at 60 days. Clinical Trial Registration- URL: http://www.clinicaltrials.gov. Unique identifiers: NCT00328692 and NCT00354458.
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