Increased levels of cardiac Troponin-T in outpatients with heart failure and preserved systolic function are related with worse clinical findings and adverse outcome

Abstract

Background: Increased levels of cardiac troponin T (cTnT) have been reported in chronic heart failure with low ejection fraction, and this finding was associated with measures of disease severity and poor prognosis. However, the prevalence and prognostic usefulness of myocardial damage in the presence of diastolic dysfunction has been poorly evaluated. The hypothesis of this study was that many mechanism could trigger increasing of cTnT levels in HF patients with preserved systolic function, and it would be related with both disease severity and prognosis. Methods: Clinical, echocardiographic, 6 minute walk test distance, and laboratory data were prospectively obtained in 69 CHF outpatients with ejection fraction (EF) >=40%. Blood samples were assayed for cTnT with a 3rd generation immunoassay and values >=0.02 ng/mL were considered abnormal. Patients were followed-up during a mean of 6 months Results: Increased levels of cTnT at baseline, 3- and 6-months were found in 13%, 21% and 7% with mean cTnT value of 0.044±0.028 ng/mL, 0.048±0.042 ng/mL and 0.071±0.054 ng/mL. Thus, cTnT level >=0.02 ng/mL in at least one sample was found in 21 patients (34%, Group 1). Comparisons between Group 1 patients and those with normal cTnT levels (Group 2) are shown in the table 1. In a multiple regression analysis, hospital admissions during the previous year (p = 0.049, HR = 4.30, IC 1.01-18.37), low systolic blood pressure (p = 0.048, HR = 0.96, IC 0.93-0.99), and age (p = 0.045, HR = 1.07, IC 1.001-1.14) were independent predictors of myocardial damage. In patients with elevated and normal cTnT levels, the rates of death was 19 vs 0% (p = 0.002), and worsening- CHF was 52.4 vs. 18.8% (p = 0.005). Eight-month free CHF-hospitalization survival was 61% in Group 1 and. 96% in Group 2 (log rank test p = 0.0001). Conclusion: One third of CHF outpatients with preserved systolic function had increased cTnT levels and it correlated with clinical measures of disease severity. Previous clinical instability, low systolic pressure and aging were independent markers of elevated cTnT. Moreover, ongoing myocardial damage was associated with worse long term-prognosis suggesting a relationship with progression of heart failure.Table 1cTnT>=0.02 ng/mLCTnT<0.02 ng/mLp valueAge (years,SD)71.2±1064±12.50.024Prior hospital admission62%31.3%0.017Systolic blood pressure (mmHg,SD)128.1±21.3139.5±22.40.056Ischemic etiology57.1%43.8%NSNYHA class (means,SD)2.8±0.82.1±0.90.003LVEF (%,SD)53.3±9.653.9±8.5NS6 min walk test (meters,SD)328±110385±980.056Diabetes mellitus33.3%20.8%NS Open table in a new tab Background: Increased levels of cardiac troponin T (cTnT) have been reported in chronic heart failure with low ejection fraction, and this finding was associated with measures of disease severity and poor prognosis. However, the prevalence and prognostic usefulness of myocardial damage in the presence of diastolic dysfunction has been poorly evaluated. The hypothesis of this study was that many mechanism could trigger increasing of cTnT levels in HF patients with preserved systolic function, and it would be related with both disease severity and prognosis. Methods: Clinical, echocardiographic, 6 minute walk test distance, and laboratory data were prospectively obtained in 69 CHF outpatients with ejection fraction (EF) >=40%. Blood samples were assayed for cTnT with a 3rd generation immunoassay and values >=0.02 ng/mL were considered abnormal. Patients were followed-up during a mean of 6 months Results: Increased levels of cTnT at baseline, 3- and 6-months were found in 13%, 21% and 7% with mean cTnT value of 0.044±0.028 ng/mL, 0.048±0.042 ng/mL and 0.071±0.054 ng/mL. Thus, cTnT level >=0.02 ng/mL in at least one sample was found in 21 patients (34%, Group 1). Comparisons between Group 1 patients and those with normal cTnT levels (Group 2) are shown in the table 1. In a multiple regression analysis, hospital admissions during the previous year (p = 0.049, HR = 4.30, IC 1.01-18.37), low systolic blood pressure (p = 0.048, HR = 0.96, IC 0.93-0.99), and age (p = 0.045, HR = 1.07, IC 1.001-1.14) were independent predictors of myocardial damage. In patients with elevated and normal cTnT levels, the rates of death was 19 vs 0% (p = 0.002), and worsening- CHF was 52.4 vs. 18.8% (p = 0.005). Eight-month free CHF-hospitalization survival was 61% in Group 1 and. 96% in Group 2 (log rank test p = 0.0001). Conclusion: One third of CHF outpatients with preserved systolic function had increased cTnT levels and it correlated with clinical measures of disease severity. Previous clinical instability, low systolic pressure and aging were independent markers of elevated cTnT. Moreover, ongoing myocardial damage was associated with worse long term-prognosis suggesting a relationship with progression of heart failure.