Impact of Serial Troponin Release on Outcomes in Patients With Acute Heart Failure

Abstract

Background-Cardiac troponin T (cTnT) elevation is common and is a predictor of outcomes in patients with acute heart failure (AHF). The degree and progression of cTnT release during hospitalization of patients with AHF is unclear. We evaluated the incidence of cTnT release during AHF hospitalization and the relationship of cTnT release with outcomes. Methods and Results-The Placebo-controlled Randomized study of the selective A(1) adenosine receptor antagonist rolofylline for patients hospitalized with acute heart failure and volume Overload to assess Treatment Effect on Congestion and renal funcTion (PROTECT) pilot study was a multicenter, double-blind study of patients with AHF. Measurements of cTnT were collected at randomization and days 2, 3, 4, and 7. Patients were classified on the basis of their serum cTnT levels at baseline: positive (Ͼ0.03 ng/mL), detectable (Ͼ0.01 ng/mL), and negative (Յ0.01 ng/mL). A detectable cTnT level developed during the study (after baseline) was classified as cTnT conversion: 288 patients were included; 172 (60%) patients had detectable cTnT levels and 97 (34%) had positive values (Ͼ0.03 ng/mL) at baseline. Of the 116 patients with negative troponin at baseline, 24 (21%) had elevated cTnT levels by day 7. On multivariable analysis, positive cTnT at baseline was an independent predictor of the composite end point of cardiovascular/renal rehospitalization or death at 60 days (hazard ratio, 1.84; 95% confidence interval, 1.04 -3.26; Pϭ0.036). Kaplan-Meier curves showed similar worse outcomes in patients with troponin conversion and positive troponin at baseline. Conclusions-There was a high prevalence of baseline cTnT elevation in this cohort; 21% of those negative at baseline converted to detectable levels by day 7. Positive troponin at baseline, and conversion to positive levels, were associated with worse outcomes at 60 days. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifiers: NCT00328692 and NCT00354458. (Circ Heart Fail. 2011;4:724-732.)

Role of Biomarkers for the Prevention, Assessment, and Management of Heart Failure: A Scientific Statement From the American Heart Association

“…155 In addition to the natriuretic peptides, there is a substantial literature on other biomarkers at the time of AHF hospitalization and subsequent risk. cTns have been shown in some studies, 175,177,185,186 but not others, 187 to predict postdischarge events. Some of these variations may be the result of differences in patient characteristics, troponin assay characteristics (which vary markedly 188 ), or possible publication bias.…”

Is Worsening Renal Function an Ominous Prognostic Sign in Patients With Acute Heart Failure?

“…However, the diagnosis based solely on clinical signs is less accurate compared when biomarkers and/or dynamic maneuvers are used. 38 In addition, the use of other biomarkers [33][34][35][36][37] and/or of their serial changes during hospitalization 15,36,40 might have yielded a better prognostic assessment, although this is not generally done in everyday clinical practice, yet.…”

Mode of Death After Acute Heart Failure Hospitalization – A Clue to Possible Mechanisms –

“…In addition to baseline values, a rise in serum troponin levels during the hospitalization, an index of eventrelated myocardial necrosis, is also a powerful predictor of outcome. 70, 71 The relationship between chronic renal dysfunction and/or worsening renal function and poor outcomes in patients with HF is well established. 72, 73 However, there are important exceptions to this because an increase in serum creatinine may have neutral, or even favorable, significance when it occurs after intensive diuretic treatment or after the initiation of renin-angiotensin inhibitor therapy.…”