Minor myocardial damage detected by troponin T is a powerful predictor of long-term prognosis in patients with acute decompensated heart failure

• Published in: International journal of cardiology Vol. 99; no. 2; pp. 253 - 261
• Main Authors: Perna, Eduardo R., Macı́n, Stella M., Cimbaro Canella, Juan P., Alvarenga, Pablo M., Rı́os, Nelson G., Pantich, Rolando, Augier, Natalia, Farı́as, Eduardo F., Jantus, Eloı́sa, Brizuela, Monica, Medina, Fernanda
• Format: Journal Article
• Language: English
• Published: Shannon Elsevier Ireland Ltd 18-03-2005; Elsevier Science
• Subjects: Acute Disease; Aged; Biochemical marker; Biological and medical sciences; Cardiology. Vascular system; Disease Progression; Echocardiography; Electrocardiography; Female; Heart; Heart Failure - blood; Heart Failure - complications; Heart Failure - mortality; Heart failure, cardiogenic pulmonary edema, cardiac enlargement; Heart Ventricles - diagnostic imaging; Heart Ventricles - physiopathology; Hospital Mortality; Humans; Male; Medical sciences; Middle Aged; Myocardial Ischemia - blood; Myocardial Ischemia - etiology; Myocardial Ischemia - physiopathology; Predictive Value of Tests; Prognosis; Prospective Studies; Risk stratification; Troponin T; Troponin T - blood; Ventricular Function, Left - physiology; Worsening heart failure; Worsening heart failure; Biochemical marker; Risk stratification; Troponin T; Human; Heart failure; Prognosis; Predictor; Acute; Prediction; Cardiovascular disease; Risk; Worsening heart failure: Risk stratification; Long term; Heart disease; Risk factor; Myocardium; Minor; Predictive factor; Stratification; Aggravation
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2004.01.017

Background: The progression of chronic heart failure (CHF) is characterized by frequent exacerbation requiring hospitalization and high mortality. Clinical deterioration is triggered by many factors that could promote ongoing myocytes injury. We sought to determine whether a specific marker of cardiac injury, troponin T (cTnT), is associated with prognosis in acute decompensated heart failure (ADHF).
Methods: One hundred and eighty-four consecutive patients with ADHF were enrolled in the absence of an acute coronary syndrome. A cTnT value≥0.1 ng/ml in samples drawn at 6, 12 or 24 h after hospital admission was considered abnormal.
Results: Increased levels of cTnT were found in 58 patients (31.5%, group 1). There were no significant differences between group 1 and patients with cTnT<0.1 ng/ml (group 2) in terms of demographic and clinical characteristics, although ischemic etiology was more prevalent in group 1 (51.7% vs. 31.7%,
p=0.009). During follow-up, the mortality in groups 1 and 2 was 31% and 17.5% (
p=0.038, OR=2.13, 95% CI: 1.03–4.69), respectively. The 3-year free-CHF readmission survival in group 1 and 2 was 25% and 53% (log rank test
p=0.015). In a Cox proportional hazard model, poor tissue perfusion (HR=2.46, 95% CI=1.31–4.6), previous infarction (HR=1.99, 95% CI=1.02–3.9) and cTnT≥0.1 ng/ml (HR=1.74, 95% CI=1.05–2.9) emerged as the independent predictors of long-term outcome.
Conclusions: One third of patients with decompensated CHF had elevated levels of cTnT. Troponin T was an independent long-term prognostic marker of morbidity and mortality and it suggests a role of biochemical risk stratification in this setting.