High-sensitivity cardiac troponin T, left ventricular function, and outcome in non-ST elevation acute coronary
K M Eggers1, T Jernberg2, B Lindahl1
1Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Uppsala.
Insights
High-sensitivity cardiac troponin T (hs-cTnT) levels offer crucial prognostic information beyond left ventricular ejection fraction (LVEF) in non-ST elevation acute coronary syndrome (NSTE-ACS) patients, aiding in risk stratification and guiding treatment decisions.
Area of Science:
- Cardiology
- Biomarkers
- Acute Coronary Syndromes
Background:
- Cardiac troponin (cTn) levels correlate with infarct size and left ventricular ejection fraction (LVEF) in non-ST elevation acute coronary syndrome (NSTE-ACS).
- Limited data exists on the incremental prognostic value of high-sensitivity troponin (hs-cTn) assays over LVEF in NSTE-ACS.
Purpose of the Study:
- To investigate whether hs-cTnT provides additional prognostic information to LVEF in NSTE-ACS patients.
- To assess the predictive value of hs-cTnT for major cardiovascular events (MACE) across different LVEF categories.
Main Methods:
- A registry-based study using the SWEDEHEART registry.
- Included 20,652 NSTE-ACS patients with available hs-cTnT and LVEF data.
- Follow-up duration of 1 year.
Main Results:
- Hs-cTnT levels independently predicted MACE across all LVEF strata (normal to severely depressed).
- Hs-cTnT was particularly predictive of cardiovascular mortality and heart failure readmission.
- These associations remained consistent even after excluding patients with prior cardiac disease.
Conclusions:
- Hs-cTnT levels offer incremental prognostic value independent of LVEF in NSTE-ACS.
- Hs-cTnT is a strong predictor of MACE in NSTE-ACS patients, including those with normal LVEF.
- A normal LVEF should not preclude thorough patient workup.
Background:
Cardiac troponin (cTn) levels reflect infarct size and depressed left ventricular ejection fraction (LVEF) in patients with non-ST elevation acute coronary syndrome (NSTE-ACS). However, there is very limited information on whether cTn measured with a high-sensitivity (hs) assay would provide incremental prognostic information to the LVEF in NSTE-ACS patients.
Methods:
This was a registry-based study (SWEDEHEART registry) investigating 20,652 NSTE-ACS patients with available information on hs-cTnT (highest level recorded during the hospitalization) and the LVEF estimated using echocardiography. All patients had been followed for 1 year.
Results:
Hs-cTnT levels independently predicted major cardiovascular events (MACE) in cohorts with normal, slightly depressed, moderately depressed, and severely depressed LVEF. The adjusted hazard ratios in these cohorts were 1.18 (95% CI 1.13-1.23), 1.12 (95% CI 1.06-1.18), 1.12 (95% CI 1.06-1.19), and 1.21 (95% CI 1.13-1.30), respectively. Hs-cTnT levels were particularly predictive for cardiovascular mortality and readmission for heart failure. Excluding patients with previous cardiac disease did not affect the overall interrelations of hs-cTnT and LVEF with MACE.
Conclusions:
Hs-cTnT levels provide incremental prognostic value independent of the LVEF in patients with NSTE-ACS. Hs-cTnT is particularly predictive for MACE in patients with severely depressed LVEF but also in those with a normal LVEF. Accordingly, a normal LVEF should not be used as an argument not to target patients to thorough workup.
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