Abstract
High-sensitive troponin T (hs-TnT) is increasingly used for prognostication in patients with acute heart failure (AHF). However, uncertainty exists whether hs-TnT shows comparable prognostic performance in patients with heart failure and different classes of left ventricular ejection fraction (LV-EF). The aim of the present study was to assess the prognostic value of hs-TnT for the prediction of 30-day mortality depending on the presence of HF with preserved ejection fraction (HFpEF), HF with mid-range LV-EF (HFmrEF) and HF with reduced LV-EF (HFrEF) in patients with acutely decompensated HF. Patients admitted to our institution due to AHF were retrospectively included. Clinical information was gathered from electronic and paper-based patient charts. Patients with myocardial infarction were excluded. A total of 847 patients were enrolled into the present study. A significant association was found between HF groups and hs-TnT (regression coefficient -0.018 for HFpEF vs. HFmrEF/HFrEF; p = 0.02). The area under the curve (AUC) of hs-TnT for the prediction of 30-mortality was significantly lower in patients with HFpEF (AUC 0.61) than those with HFmrEF (AUC 0.80; p = 0.01) and HFrEF (AUC 0.73; p = 0.04). Hs-TnT was not independently associated with 30-day outcome in the HFpEF group (OR 1.48 [95%-CI 0.89–2.46]; p = 0.13) in contrast to the HFmrEF group (OR 4.53 [95%-CI 1.85–11.1]; p < 0.001) and HFrEF group (OR 2.58 [95%-CI 1.57–4.23]; p < 0.001). Prognostic accuracy of hs-TnT in patients hospitalized for AHF regarding 30-day mortality is significantly lower in patients with HFpEF compared to those with HFmrEF and HFrEF.
Highlights
There is increasing evidence regarding the prognostic potential of cardiac troponin in patients with acute heart failure (AHF) [1,2,3,4]
Patients were categorized into three different groups of HF and left ventricular ejection fraction (LV-EF) according to current guidelines (HFpEF vs. HF with mid-range LV-EF (HFmrEF) vs. HF with reduced LV-EF (HFrEF)) [16]
LV diameter were smaller and RV systolic function was higher in HF with preserved ejection fraction (HFpEF) patients compared to those with HFmrEF and HFrEF
Summary
There is increasing evidence regarding the prognostic potential of cardiac troponin in patients with acute heart failure (AHF) [1,2,3,4]. Heart and Vessels of high sensitivity troponin assays [3, 11]. This represents a relevant diagnostic dilemma since approximately 40–50% of patients admitted for AHF have HFpEF [12, 13]. There are well-validated risk scores in AHF such as the MEESSI score [14, 15], data regarding adequate prognostication using biomarkers in these patients are scarce. The present study sought to evaluate hs-TnT based clinical outcome prediction in patients with different HF groups (HFpEF, HFmrEF and HFrEF) in a large all-comer AHF population
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