P1653Admission high-sensitivity troponin T and NT-proBNP for outcome prediction in acute heart failure

Abstract Background High-sensitivity troponin T (hs-TnT) reflects the severity of ongoing myocardial damage and holds independent prognostic significance in chronic heart failure (HF). In acute HF (AHF), its additive prognostic value over natriuretic peptides is unclear. Methods Individual data of 1571 AHF patients with admission hs-TnT were collected from 3 cohorts. Results Patients were aged 78±10 years, and 51% were men. Median hs-TnT and N-terminal fraction of pro-B-type natriuretic peptide (NT-proBNP) concentrations were 43 ng/L (interquartile interval 26–69) and 5660 (2693–12466), respectively. Patients experiencing in-hospital death (n=187, 13%) had significantly higher hs-TnT and NT-proBNP on admission (both p<0.001). The risk of in-hospital death increased by 45% per each doubling of hs-TnT (HR 1.45, 95% confidence interval - CI 1.31–1.59, p<0.001), and by 32% per each doubling of NT-proBNP (HR 1.32, 95% CI 1.17–1.50, p<0.001). Patients with hs-TnT ≥43 ng/L and NT-proBNP ≥5660 ng/L had a 2.7-fold higher risk of in-hospital death (relative risk - RR 2.7, 95% CI 1.7–4.5). Among the 1262 patients discharged, 1024 deaths occurred over a median 11-month follow-up (4–22). In a model including NT-proBNP, hs-TnT ≥43 ng/L was a strong, independent predictor of all-cause death at 6, 12 and 24 months, and the composite of cardiovascular death or HF hospitalization at 6 and 24 months. hs-TnT ≥43 ng/L also improved risk reclassification. Conclusions The risk of in-hospital death is almost 3 folds higher with admission hs-TnT ≥43 ng/L and NT-proBNP ≥5660 ng/L, and hs-TnT ≥43 ng/L holds strong independent prognostic significance for post-discharge outcome.

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High-Sensitivity Troponin T: A Biomarker for Diuretic Response in Decompensated Heart Failure Patients

Cardiology Research and Practice ◽

10.1155/2014/269604 ◽

2014 ◽

Vol 2014 ◽

pp. 1-9 ◽

Cited By ~ 6

Author(s):

João Pedro Ferreira ◽

Mário Santos ◽

Sofia Almeida ◽

Irene Marques ◽

Paulo Bettencourt ◽

...

Keyword(s):

Heart Failure ◽

Troponin T ◽

Secondary Analysis ◽

Myocardial Damage ◽

High Sensitivity ◽

Decompensated Heart Failure ◽

Blood Levels ◽

Heart Failure Patients ◽

High Sensitivity Troponin ◽

High Sensitivity Troponin T

Background.Patients presenting with acutely decompensated heart failure (ADHF) and positive circulating cardiac troponins were found to be a high-risk cohort. The advent of high-sensitive troponins resulted in a detection of positive troponins in a great proportion of heart failure patients. However, the pathophysiological significance of this phenomenon is not completely clear.Objectives.The aim of this study is to determine the early evolution and clinical significance of high-sensitivity troponin T (hsTnT) in ADHF.Methods.Retrospective, secondary analysis of a prospective study including 100 patients with ADHF.Results.Globally, high-sensitivity troponin T decreased from day 1 to day 3(P=0,039). However, in the subgroup of patients who remained decompensated no significant differences in hsTnT from day 1 to day 3 were observed(P=0,955), whereas in successfully compensated patients a significant reduction in hsTnT levels was observed(P=0,025). High-sensitivity troponin T decrease was correlated with NTproBNP reduction(P=0,007). Patients with hsTnT increase had longer length of stay(P=0,033).Conclusions.Episodes of ADHF are associated with transient increases in the blood levels of hsTnT that are reduced with effective acute episode treatment. The decrease in hsTnT can translate less myocardial damage along with favourable ADHF treatment.

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Abstract 12777: High Sensitivity Troponin T is Associated With Increased Heart Failure Risk in Metabolic Syndrome in the Atherosclerosis Risk in Communities (ARIC) Study

Circulation ◽

10.1161/circ.130.suppl_2.12777 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Yashashwi Pokharel ◽

Wensheng Sun ◽

Dennis Villarael ◽

Elizabeth Selvin ◽

Salim Virani ◽

...

Keyword(s):

Heart Failure ◽

Metabolic Syndrome ◽

Myocardial Injury ◽

Troponin T ◽

Cox Model ◽

High Sensitivity ◽

Cvd Risk ◽

Chi Square ◽

High Sensitivity Troponin ◽

High Sensitivity Troponin T

Background: Metabolic syndrome (MS) is associated with higher CVD risk. High sensitivity troponin T (hsTnT) is a marker of myocardial injury and an emerging marker for heart failure (HF) risk prediction. We examined whether hsTnT is associated with increased HF risk in people with similar number of MS components present at baseline in 10316 ARIC participants without prevalent HF. Methods: We used Wald Chi-square test to assess the interaction between MS and hsTnT and Cox model for the association of incident HF hospitalization by hsTnT categories across groups created by the number of MS components after adjusting for risk factors and NT-proBNP (Table). Results: The mean age of the study population was 63 (SD, 6) years (56% women). Mean hsTnT levels were higher with increasing MS components (Table). There were 1353 HF hospitalizations over a median of 14 years. The interaction of MS with hsTnT for HF was borderline significant (p-interaction 0.059). Compared to individuals without MS and hsTnT<5 ng/L the HRs (95%CIs) were 1.7 (1.4-2.1) in those without MS and hsTnT≥5 ng/L; 1.7 (1.3-2.1) in MS and hsTnT<5 ng/L; and 3.6 (3.0-4.4) in MS and hsTnT≥5 ng/L. In groups with 1-5 MS components present, increasing hsTnT was significantly associated with higher hazards for HF in each group with the highest HR in those with all 5 MS components (Table). Conclusion: Presence of higher MS risk components was associated with increasing subclinical myocardial injury as assessed by higher hsTnT. The hazards for HF were numerically similar in individuals without MS but detectable hsTnT (>5 ng/L) as to those with MS but undetectable hsTnT. In people with similar number of MS components higher hsTnT levels were associated with increased HF hazards suggesting that in MS hsTnT could be a useful marker for identifying those at higher risk for incident HF.

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