Highly sensitive troponin T for risk stratification of acutely destabilized heart failure
Domingo A Pascual-Figal1, Teresa Casas, Jordi Ordonez-Llanos
1Cardiology Department, Virgen de la Arrixaca Hospital and School of Medicine, University of Murcia, Murcia, Spain. dpascual@um.es
Insights
A new highly sensitive troponin T (hsTnT) assay detects nearly universal myocardial necrosis in acutely decompensated heart failure (ADHF). hsTnT offers prognostic value when conventional troponin T is negative or imprecise.
Area of Science:
- Cardiology
- Biomarkers
- Heart Failure Research
Background:
- A novel highly sensitive troponin T (hsTnT) assay enables precise detection of minor myocardial necrosis.
- The incremental prognostic value of hsTnT over conventional troponin T (cTnT) in acutely decompensated heart failure (ADHF) remains under investigation.
Purpose of the Study:
- To evaluate if hsTnT offers additional prognostic accuracy beyond cTnT in ADHF patients.
- To compare the prognostic capabilities of hsTnT and cTnT for predicting mortality in ADHF.
Main Methods:
- 202 consecutive ADHF patients without acute myocardial infarction criteria were studied.
- Troponin T levels were measured using both hsTnT and cTnT assays.
- Patients were followed for a median of 406 days to ascertain all-cause mortality.
Main Results:
- hsTnT detected measurable troponin T in 98% of patients, compared to 56% for cTnT.
- hsTnT reclassified 60% of patients with undetectable cTnT, with 81% above the 99th percentile.
- While both assays predicted mortality, hsTnT significantly improved prediction in patients with low or undetectable cTnT (P = .01).
Conclusions:
- Myocardial necrosis is nearly ubiquitous in ADHF patients as detected by hsTnT.
- hsTnT provides comparable prognostic information to cTnT overall.
- hsTnT offers significant prognostic insights in ADHF patients with negative or imprecise cTnT results.
Background:
A highly sensitive assay for troponin T (hsTnT) has been recently developed, which allows for the detection of even minor myocardial necrosis with high precision. It remains unexplored whether hsTnT provides incremental prognostic accuracy beyond conventional (c)TnT in patients with acutely decompensated heart failure (ADHF).
Methods:
A total of 202 consecutive patients admitted with ADHF and without criteria for acute myocardial infarction were studied. Troponin T was measured using the highly sensitive assay and compared with the conventional method. Patients were clinically followed up at a median of 406 days, with a primary outcome measure of all-cause mortality.
Results:
The high-sensitive assay detected measurable TnT in 98% of patients vs 56% for cTnT; 81% had an hsTnT above the 99th percentile for a healthy reference population, and it reclassified 60% of those with undetectable cTnT. Both TnT methods predicted the risk of death in adjusted multivariable Cox regression analyses, without a superiority of hsTnT over cTnT in the entire population (area under the curve 0.67 vs 0.71, P = .2). Among patients with a cTnT below 0.03 ng/mL (the lowest cut-point with <10% imprecision; n = 134), solely hsTnT improved the prediction of death over clinical risk factors (relative integrated discrimination improvement +36%, P = .01) and hsTnT above 20 pg/mL identified a significant higher risk of death (hazard ratio 4.7, 95% CI 1.6-13.8, P = .005).
Conclusion:
Among patients with ADHF, myocardial necrosis (as detected with the hsTnT assay) was nearly ubiquitous. The highly sensitive assay for TnT provides comparable prognostic information to cTnT overall, but among those in whom the cTnT method was less precise or frankly negative, the hsTnT assay provided prognostic information.
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