Abstract
BackgroundHigh-sensitive cardiac troponin T (hsTnT) is a sensitive biomarker of myocardial damage and predictor of acute decompensated heart failure (ADHF). However, there is little information on changes over time in hsTnT level during ADHF management. The aim of this prospective study was to evaluate changes in hsTnT levels between admission and at discharge in patients with ADHF, and identify factors that determine such levels and their prognostic significance.Methods and resultsWe evaluated 404 ADHF patients with abnormal hsTnT levels (≥0.0135 ng/ml) on admission. The median (interquartile ranges) hsTnT levels on admission, at discharge, and percent changes in hsTnT levels were 0.038 (0.026 to 0.065), 0.032 (0.021 to 0.049) ng/ml, and -12.0 (-39.8 to 7.4) % respectively. The numbers of patients with falling (hsTnT decrease > -15%), stable (hsTnT change between -15 and +15%) and rising (hsTnT increase > +15%) hsTnT level at discharge were 190, 146, and 68, respectively. The percent change in B-type natriuretic peptide (BNP) levels was greater in the falling group, compared to the stable (p<0.001) and rising groups (p<0.001). Changes in hsTnT levels correlated significantly with changes in BNP levels (ρ = 0.22, p<0.001). Multivariate Cox regression analysis identified rising or stable hsTnT at discharge as a significant predictor of heart failure-related rehospitalization (hazard ratio: 1.69; 95% confidence interval: 1.06 to 2.70; p = 0.03).ConclusionsPersistent increase in hsTnT levels at discharge correlated with inadequate decrease of BNP levels, and was a predictor of poor clinical outcome, with repeat heart failure hospitalizations.
Highlights
Persistent and modest elevation in circulating cardiac troponin level is frequently observed in patients with heart failure (HF) and is considered to represent ongoing subclinical myocardial damage [1]
Persistent increase in high-sensitivity cardiac troponin T levels (hsTnT) levels at discharge correlated with inadequate decrease of B-type natriuretic peptide (BNP) levels, and was a predictor of poor clinical outcome, with repeat heart failure hospitalizations
Several studies have reported that a serial increase in cardiac troponin levels during acute decompensated heart failure (ADHF) management is a predictor of poor clinical outcome in such patients [8,9,10]
Summary
Persistent and modest elevation in circulating cardiac troponin level is frequently observed in patients with heart failure (HF) and is considered to represent ongoing subclinical myocardial damage [1]. Since the exacerbation of HF causes additional myocardial damage due to activation of the above factors, cardiac troponin levels are significantly elevated in patients with acute decompensated heart failure (ADHF) compared to the compensated state [7]. The present study was designed to determine differences in high-sensitivity cardiac troponin T levels (hsTnT) measured on admission to and at discharge from the hospital, and identify the factors that determine such levels and their prognostic significance. High-sensitive cardiac troponin T (hsTnT) is a sensitive biomarker of myocardial damage and predictor of acute decompensated heart failure (ADHF). There is little information on changes over time in hsTnT level during ADHF management The aim of this prospective study was to evaluate changes in hsTnT levels between admission and at discharge in patients with ADHF, and identify factors that determine such levels and their prognostic significance
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