Prognostic implication of progressive myocardial cell loss in severe heart failure: usefulness of cardiac troponin T monitoring to identifying high risk patients

Patients with advanced heart failure (NYHA FC III and IV heart failure) had positive cardiac troponin levels in previous cohort studies. In heart failure, cardiac troponin T (cTnT) is a biomarker that is sensitive to myocardial damage, especially myocardial necrosis. However, there is still little information regarding changes in cTnT levels during standard therapy. This prospective observational study is aimed at evaluating changes in cTnT levels before and after the administration of standard therapy and evaluating symptom improvement before and after the administration of standard therapy in patients with severe heart failure. Measurement of cTnT levels and symptom improvement parameters before treatment was carried out on the first day of the inpatient and measurement after therapy was carried out on the last day of the inpatient. Sampling was done by consecutive sampling and found 30 patients in the inpatient room of the SMF Cardiovascular Disease, Dr. Soetomo Hospital, Surabaya during the months of May-July 2017. The results of the study obtained the average cTnT levels before therapy 33.48 + 31.88 pg/ml and the average cTnT levels after therapy 46.32 + 52.68 pg/ml. Based on the statistical difference test with the Wilcoxon sign-ranked test, there was no significant change in cTnT levels (p = 0.318). On the parameter of clinical symptom improvement, there was a significant decrease in pulse, respiratory rate, blood pressure, and mean arterial pressure before and after administration of therapy (p <0.05). There was no change in troponin T levels before and after the administration of therapy meant there was no worsening of myocardial necrosis.

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Prognostic Value of Combination of Cardiac Troponin T and B-Type Natriuretic Peptide after Initiation of Treatment in Patients with Chronic Heart Failure

Clinical Chemistry ◽

10.1373/clinchem.2003.021311 ◽

2003 ◽

Vol 49 (12) ◽

pp. 2020-2026 ◽

Cited By ~ 66

Author(s):

Junnichi Ishii ◽

Wei Cui ◽

Fumihiko Kitagawa ◽

Takahiro Kuno ◽

Yuu Nakamura ◽

...

Keyword(s):

Heart Failure ◽

Chronic Heart Failure ◽

Cardiac Troponin ◽

Troponin T ◽

Myocardial Damage ◽

Left Ventricular ◽

Functional Class ◽

Cardiac Troponin T ◽

Cardiac Events ◽

Nyha Functional Class

Abstract Background: Recent studies have suggested that cardiac troponin T (cTnT) and troponin I may detect ongoing myocardial damage involved in the progression of chronic heart failure (CHF). This study was prospectively designed to examine whether the combination of cTnT, a marker for ongoing myocardial damage, and B-type natriuretic peptide (BNP), a marker for left ventricular overload, would effectively stratify patients with CHF after initiation of treatment. Methods: We measured serum cTnT, plasma BNP, and left ventricular ejection fraction (LVEF) on admission for worsening CHF [New York Heart Association (NYHA) functional class III to IV] and 2 months after initiation of treatment to stabilize CHF (n = 100; mean age, 68 years). Results: Mean (SD) concentrations of cTnT [0.023 (0.066) vs 0.063 (0.20) μg/L] and BNP [249 (276) vs 753 (598) ng/L], percentage increased cTnT (>0.01 μg/L; 35% vs 60%), NYHA functional class [2.5 (0.6) vs 3.5 (5)], and LVEF [43 (13)% vs 36 (12)%] were significantly (P <0.01) improved 2 months after treatment compared with admission. During a mean follow-up of 391 days, there were 44 cardiac events, including 12 cardiac deaths and 32 readmissions for worsening CHF. On a stepwise Cox regression analysis, increased cTnT and BNP were independent predictors of cardiac events (P <0.001). cTnT >0.01 μg/L and/or BNP >160 ng/L 2 months after initiation of treatment were associated with increased cardiac mortality and morbidity rates. Conclusion: The combination of cTnT and BNP measurements after initiation of treatment may be highly effective for risk stratification in patients with CHF.

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Abstract 15285: Prognostic Value of 6-year Change in High Sensitivity Cardiac Troponin-T for Risk of Heart Failure, Heart Failure Subtype, and Death

Circulation ◽

10.1161/circ.132.suppl_3.15285 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Bill Mcevoy ◽

Chiadi E Ndumele ◽

Yuan Chen ◽

Scott D Solomon ◽

Michael Steffes ◽

...

Keyword(s):

Heart Failure ◽

Ejection Fraction ◽

Cardiac Troponin ◽

Proportional Hazards ◽

Troponin T ◽

High Sensitivity ◽

Sensitivity Analyses ◽

Cardiac Troponin T ◽

Reduced Ejection Fraction ◽

Relative Change

Background: Serial changes in high-sensitivity cardiac troponin-T (hs-cTNT) indicate progressive subclinical myocardial damage and have been associated with heart failure (HF) and death in asymptomatic older adults. Whether these associations exist in middle-age and whether serial hs-cTNT is more strongly associated with HF with reduced ejection fraction (HFREF) or HF with preserved ejection fraction (HFPEF) is poorly understood. Methods: We studied 8,838 participants of the Atherosclerosis Risk in Communities Study, initially free of coronary heart disease and HF, who had hs-cTNT measured at two time-points, 6 years apart. Using proportional hazards regression, we examined the association of absolute and relative change in hs-cTNT with incident HF hospitalization or death. Sensitivity analyses for HFPEF and HFREF were also conducted. Results: Mean age at baseline was 57 years, 57% were female and 21% were black. Over a maximum of 16 years follow-up there were 965 HF events and 1813 deaths. In adjusted models, incident detectable hs-cTNT (≥5ng/L) was associated with subsequent HF (Hazard Ratio [HR] 1.86, 95% Confidence Interval [CI] 1.53-2.25) and death (1.46 [1.28-1.68]). HRs were larger for incident hs-cTNT elevation (≥14ng/L) but similar for those with a relative increase >50% from baseline hs-cTNT (Table). In contrast, risk was lower for relative reductions >50% from baseline hs-cTNT. Temporal increases in hs-cTNT were associated with both HFREF and HFPEF in categorical analyses, however, when modeled continuously (per SD increase), absolute 6-year hs-cTNT change appeared to be more strongly associated with HFPEF hospitalization (HR 1.30 [1.06-1.60]) than with HFREF hospitalization (1.08 [0.88-1.33]). Conclusions: Absolute and relative change in hs-cTNT were independently associated with incident CHD, HF and death, even after adjustment for baseline hs-cTNT. Associations were generally consistent for both the HFREF and HFPEF phenotypes

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