The Prognostic Value of Troponin Levels Adjusted for Renal Function in Heart Failure - A Systematic Review
Anca Breha1,2, Caterina Delcea1,2, Andreea Cristina Ivanescu1,2
1"Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.
Insights
High-sensitivity troponins (hs-cTnT and hs-cTnI) predict mortality in heart failure patients, even with kidney issues. However, their ability to predict heart failure hospitalizations is less reliable.
Area of Science:
- Cardiology
- Biomarker Research
- Renal Medicine
Background:
- Heart failure (HF) presents a major global health challenge with significant morbidity and mortality.
- Accurate prognostic biomarkers are essential for effective HF management.
- High-sensitivity cardiac troponins T (hs-cTnT) and I (hs-cTnI) are key indicators, but their predictive power can be influenced by comorbidities like renal dysfunction.
Purpose of the Study:
- To review the prognostic significance of troponin levels adjusted for renal function in heart failure patients.
- To assess the independent predictive value of hs-cTnT and hs-cTnI for mortality and hospitalizations in HF.
Main Methods:
- A systematic literature search was conducted on PubMed, covering studies from 2011 to September 2024.
- MeSH terms related to heart failure, troponin, and prognosis were utilized.
- Thirty-two studies met the inclusion criteria for the review.
Main Results:
- Troponin levels adjusted for renal function were consistently associated with cardiovascular mortality in HF patients (HR 1.67-3.22).
- hs-cTnT and hs-cTnI independently predict cardiovascular mortality in acute heart failure.
- Specific hs-cTnI and hs-cTnT thresholds demonstrated significant correlations with increased all-cause mortality, even after renal function adjustment.
Conclusions:
- hs-cTnT and hs-cTnI are robust independent predictors of mortality in heart failure, irrespective of renal function.
- The predictive value of troponins for heart failure readmissions is inconsistent and less reliable, particularly in patients with advanced renal impairment.
Introduction:
Heart failure (HF) is a significant global health issue associated with high morbidity and mortality. Accurate biomarkers are crucial for predicting adverse outcomes and informing management. High-sensitivity cardiac troponins T (hs-cTnT) and I (hs-cTnI) are important prognostic indicators in HF, though their predictive value can be affected by comorbidities, particularly renal dysfunction.
Objectives:
This review evaluates the prognostic significance of troponin adjusted for renal function in patients with HF.
Methods:
A comprehensive literature search was performed in PubMed, including studies from 2011 to September 2024, using specific MeSH terms related to HF, troponin, and prognosis.
Results:
Thirty-two studies met the inclusion criteria, all indicating an association between troponin levels adjusted for renal function and cardiovascular mortality in HF patients (HR 1.67-3.22). High-sensitivity cardiac troponins T (hs-cTnT) and I (hs-cTnI) are independent predictors of cardiovascular mortality in acute heart failure (AHF). Increasing hs-cTnI levels, with a baseline threshold of 0.03 ng/mL, significantly correlate with mortality risk (P = .0011). Patients with hs-cTnT > 14 ng/L, > 21.5 ng/L, and > 26.5 ng/L exhibit increased all-cause mortality after adjusting for renal function. Despite these associations, the role of troponin in predicting heart failure readmissions remains inconsistent, indicating that elevated troponin levels do not reliably predict rehospitalization risk, particularly in those with advanced renal impairment.
Conclusions:
High-sensitivity troponins (hs-cTnT and hs-cTnI) are independent predictors of mortality in heart failure, even after accounting for renal function, while their role in predicting hospitalizations is weaker.
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