Heart failure with an elevated troponin is associated with increased morbidity and mortality: An ADHERE registry analysis

Abstract

Study objectives: The clinical implication of elevated troponin in heart failure patients is controversial. We determine outcomes in patients with decompensated heart failure and an elevated serum troponin level. Methods: The Acute Decompensated Heart Failure National Registry (ADHERE) collects data on hospital admission, therapy, and outcome in patients with a discharge diagnosis of acute decompensated heart failure. We analyzed ADHERE data from patients who had troponin testing performed at their initial evaluation. A positive troponin (Tn) level was defined as 1 ng/mL or greater for TnI or 0.1 ng/mL or greater for TnT. Patients with creatinine level greater than 2.0 mg/dL were excluded. Troponin status was compared with index visit outcomes. Systolic heart failure was defined as an ejection fraction less than 40% or moderate or severe impairment. One-way analysis of variance or χ 2 test was used for data analysis. Results: Of 67,924 patients, 30,530 (45%) were men, 49,089 (72%) were white, and 13,603 (20%) were black. Overall, 4,240 (6.2%) had a positive Tn level. At initial evaluation, Tn-positive patients had a mean systolic blood pressure of 141.2±31.6 mm Hg compared with 146.6±31.8 mm Hg in Tn-negative patients ( P P P P P P =.0217). Tn-positive patients also had longer hospitalizations (median 5.1 days [interquartile ratio (IQR) 3.2 to 8.3 days] versus 4.1 days [IQR 2.8 to 6.7 days; P P =.0005]). Tn-positive patients had an inhospital mortality rate of 8.0% versus 2.7% for Tn-negative patients ( P Conclusion: In patients with acute decompensated heart failure, elevated serum Tn is a powerful predictor of acute morbidity and mortality.