Abstract
BackgroundHigh sensitive troponin T (hsTnT) and heart fatty acid binding protein (hFABP) are both markers of myocardial injury and predict adverse outcome in patients with systolic heart failure (SHF). We tested whether hsTnT and hFABP plasma levels are elevated in patients with heart failure with normal ejection fraction (HFnEF).MethodsWe analyzed hsTnT, hFABP and N-terminal brain natriuretic peptide in 130 patients comprising 49 HFnEF patients, 51 patients with asymptomatic left ventricular diastolic dysfunction (LVDD), and 30 controls with normal diastolic function. Patients were classified to have HFnEF when the diagnostic criteria as recommended by the European Society of Cardiology were met.ResultsLevels of hs TnT and hFABP were significantly higher in patients with asymptomatic LVDD and HFnEF (both p < 0.001) compared to controls. The hsTnT levels were 5.6 [0.0-9.8] pg/ml in LVDD vs. 8.5 [3.9-17.5] pg/ml in HFnEF vs. <0.03 [< 0.03-6.4] pg/ml in controls; hFABP levels were 3029 [2533-3761] pg/ml in LVDD vs. 3669 [2918-4839] pg/ml in HFnEF vs. 2361 [1860-3081] pg/ml in controls. Furthermore, hsTnT and hFABP levels were higher in subjects with HFnEF compared to LVDD (p = 0.015 and p = 0.022).ConclusionIn HFnEF patients, hsTnT and hFABP are elevated independent of coronary artery disease, suggesting that ongoing myocardial damage plays a critical role in the pathophysiology. A combination of biomarkers and echocardiographic parameters might improve diagnostic accuracy and risk stratification of patients with HFnEF.
Highlights
High sensitive troponin T and heart fatty acid binding protein are both markers of myocardial injury and predict adverse outcome in patients with systolic heart failure (SHF)
The clinical characteristics in patients classified as to the presence or absence of left ventricular diastolic dysfunction (LVDD) or heart failure with normal ejection fraction (HFnEF) are shown in table 1, the laboratory data and parameter of cardiac assessment are highlighted in table 2
HsTnT and heart fatty acid binding protein (hFABP) levels were higher in subjects with HFnEF compared to asymptomatic LVDD (p = 0.015 and p = 0.022, respectively)
Summary
High sensitive troponin T (hsTnT) and heart fatty acid binding protein (hFABP) are both markers of myocardial injury and predict adverse outcome in patients with systolic heart failure (SHF). We tested whether hsTnT and hFABP plasma levels are elevated in patients with heart failure with normal ejection fraction (HFnEF). A highly sensitive commercial assay of cardiac troponin T (hsTnT) became available [11,12]. Using this assay, increased hsTnT levels were detected in the majority of patients with chronic systolic heart failure (SHF) [13] or ischemic heart disease, providing independent prognostic information with respect to heart failure admission and cardiovascular death [14,15]
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