Abstract
BackgroundTo assess if cardiac troponins can improve diagnostics of acute heart failure (AHF) and provide prognostic information in patients with acute dyspnea. MethodsWe measured cardiac troponin T with a high-sensitivity assay (hs-cTnT) in 314 patients hospitalized with acute dyspnea. The index diagnosis was adjudicated and AHF patients were stratified into AHF with reduced or preserved ejection fraction (HFrEF/HFpEF). The prognostic and diagnostic merit of hs-cTnT was compared to the merit of N-terminal pro-B-type natriuretic peptide (NT-proBNP). ResultsIn the total population, median age was 73 (quartile [Q] 1–3 63–81) years and 48% were women. One-hundred-forty-three patients were categorized as AHF (46%) and these patients had higher hs-cTnT concentrations than patients with non-AHF-related dyspnea: median 38 (Q1-3 22–75) vs. 13 (4–25) ng/L; p < 0.001. hs-cTnT concentrations were similar between patients with HFrEF and HFpEF (p = 0.80), in contrast to NT-proBNP, which was higher in HFrEF (p < 0.001). C-statistics for discriminating HFpEF from non-AHF-related dyspnea was 0.80 (95% CI 0.73–0.86) for hs-cTnT, 0.79 (0.73–0.86) for NT–proBNP, and 0.83 (0.76–0.89) for hs-cTnT and NT-proBNP in combination. Elevated hs-cTnT remained associated with HFpEF in logistic regression analysis after adjusting for demographics, comorbidities and renal function. During median 27 months of follow-up, 114 (36%) patients died in the total population. Higher hs-cTnT concentrations were associated with increased risk of all-cause mortality after adjustment for clinical variables and NT-proBNP: hazard ratio 1.30 (95% CI 1.07–1.58), p = 0.009. Conclusionhs-cTnT measurements improve diagnostic accuracy for HFpEF and provide independent prognostic information in unselected patients with acute dyspnea.
Highlights
Cardiac troponins are cornerstone markers for diagnosis, risk strat ification and selection of treatment strategy of acute coronary syndrome (ACS)
area under the curve (AUC) for NT-proBNP to diagnose HF with reduced EF (HFrEF) was superior to hs-cTnT: 0.89 (0.85–0.93) vs. 0.80 (0.75–0.86), p = 0.003, while we found comparable AUCs for NT-proBNP and hs-cTnT to differentiate HF with preserved EF (HFpEF) from non-Heart failure (HF)-related dyspnea: 0.79 (0.73–0.86) vs 0.80 (0.73–0.86), respectively, p = 0.95
We found hs-cTnT concentrations to be elevated in acute heart failure (AHF) patients, but in contrast to NT-proBNP, hs-cTnT concentrations were similar in HFpEF and HFrEF, and AUCs for hs-cTnT to diagnose these subgroups of AHF were comparable
Summary
Cardiac troponins are cornerstone markers for diagnosis, risk strat ification and selection of treatment strategy of acute coronary syndrome (ACS). To assess if cardiac troponins can improve diagnostics of acute heart failure (AHF) and provide prognostic information in patients with acute dyspnea. Methods: We measured cardiac troponin T with a high-sensitivity assay (hs-cTnT) in 314 patients hospitalized with acute dyspnea. The index diagnosis was adjudicated and AHF patients were stratified into AHF with reduced or preserved ejection fraction (HFrEF/HFpEF). Onehundred-forty-three patients were categorized as AHF (46%) and these patients had higher hs-cTnT concen trations than patients with non-AHF-related dyspnea: median 38 (Q1-3 22–75) vs 13 (4–25) ng/L; p < 0.001. Higher hs-cTnT concentrations were associated with increased risk of all-cause mortality after adjustment for clinical variables and NT-proBNP: hazard ratio 1.30 (95% CI 1.07–1.58), p = 0.009. Conclusion: hs-cTnT measurements improve diagnostic accuracy for HFpEF and provide independent prognostic information in unselected patients with acute dyspnea
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