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Troponin predicts mortality in heart failure-related cardiogenic shock
Benedikt N Beer1,2,3, Jonas Sundermeyer4,5, Lisa Besch4,5
1Department of Cardiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany. b.beer@uke.de.
Insights
Troponin T levels predict mortality and shock severity in heart failure-related cardiogenic shock (HF-CS). Monitoring Troponin T kinetics within 24 hours improves risk assessment for these critical patients.
Area of Science:
- Cardiology
- Biomarker Research
- Critical Care Medicine
Background:
- Predicting mortality in cardiogenic shock (CS) is crucial for treatment allocation and improving outcomes.
- Heart failure-related CS (HF-CS) accounts for nearly 50% of CS cases, yet Troponin T has been less studied in this context.
- Troponin T is a potential biomarker for risk stratification in CS patients.
Purpose of the Study:
- To evaluate the association between Troponin T levels and shock severity in HF-CS patients.
- To determine the predictive value of Troponin T, including its 24-hour kinetics, for in-hospital mortality in HF-CS.
- To assess Troponin T's correlation with the Society for Cardiovascular Angiography and Interventions (SCAI) classification of shock severity.
Main Methods:
- Retrospective analysis of 477 HF-CS patients from 15 tertiary care centers across 5 European countries (2016-2021).
- Multivariable adjusted regression models were used to assess the association of baseline high-sensitive Troponin T and its 24-hour changes with mortality.
- Correlation between Troponin T levels and SCAI shock severity stages was analyzed.
Main Results:
- Baseline high-sensitive Troponin T levels were significantly associated with in-hospital mortality (HR 1.008, p < 0.01).
- An increase in Troponin T within 24 hours indicated a 2.4-fold higher risk of death compared to decreasing levels (HR 2.439, p = 0.03).
- Higher Troponin T levels correlated with increased SCAI shock severity stages (e.g., OR 5.268 for SCAI stage D vs. C per 250 ng/l increase).
Conclusions:
- Troponin T is a significant marker of myocardial injury in HF-CS patients.
- Both baseline Troponin T levels and their 24-hour kinetics are predictive of mortality in HF-CS.
- Troponin T may serve as a valuable biomarker for guiding therapy and clinical trial enrollment in HF-CS.
Background:
In patients with cardiogenic shock (CS), predicting risk of mortality may improve treatment allocation beyond intensive care admission and thereby outcomes. Troponin appears to be a suitable biomarker but has primarily been evaluated in the setting of infarct-related CS, not in heart failure-related CS (HF-CS), which accounts for almost 50% of cases.
Objectives:
To assess the association of Troponin T with shock severity and mortality in HF-CS patients.
Methods:
Heart failure-related CS patients treated in 15 tertiary care centres (5 European countries, 2016-2021) were retrospectively enrolled (NCT03313687). Association of baseline high-sensitive Troponin T and its 24-h kinetics with shock severity according to the SCAI classification and with in-hospital mortality was assessed by fitting multivariable adjusted regression models.
Results:
N = 477 patients (mean age 62 years, 30.2% women). High-sensitive Troponin T at baseline (median 164 ng/l) was significantly associated with in-hospital mortality (HR 1.008, 95%CI 1.002-1.013, p < 0.01). Increasing Troponin within 24 h from baseline indicated a 2.4-fold higher risk of death vs. decreasing Troponin levels (HR 2.439, 95% CI 1.070-5.558, p = 0.03). In addition, higher Troponin T levels correlate with higher SCAI stages (e.g., baseline Troponin T per 250 ng/l increase: OR 5.268, 95%CI: 1.637, 16.953, p < 0.01 for SCAI stage D vs. C).
Conclusions:
Troponin T, a marker of myocardial injury, associates with shock severity in patients with heart failure-related CS. It predicts mortality both with its baseline value as well as with its 24-h kinetics. Thus, Troponin may be a suitable marker to guide therapy or clinical trial enrolment in these patients.
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