Outcomes and Care of Patients With Acute Heart Failure Syndromes and Cardiac Troponin Elevation

Abstract

A cute heart failure (HF) syndrome (AHFS) is a major reason for visits to the emergency department (ED). 1,2 Patients with AHFS represent a heterogeneous group defined by new or worsening symptoms of HF that require urgent care. 3 Although several potential underlying or precipitating factors are implicated, ischemic heart disease contributes importantly as a pathogenetic factor in AHFS. 4 It is estimated that 50% to 70% of patients with AHFS have concomitant coronary artery disease; however, optimal management of ischemic heart disease among patients with HF presenting in the acute hospital setting has not been fully elucidated. [5][6][7][8] At the current time, the management of AHFS is directed toward symptom improvement because many putative targets for acute therapy have not yielded a mortality benefit. 9-11 Recent evidence from a clinical registry suggested that patients with AHFS who underwent coronary angiography in hospital had increased use of evidence-based therapies and revascularization procedures and experienced lower mortality rates than those not undergoing the invasive procedure.12 Furthermore, patients with AFHS who underwent coronary revascularization exhibited mortality risks that did not differ from those without coronary artery disease. 13 Although an early invasive investigation and a revascularization strategy similar to that for acute coronary syndromes provide interesting possibilities to improve survival in AHFS, randomized trials have not tested this hypothesis. Background-Cardiac troponins (cTn) may be elevated among patients with acute heart failure syndromes (AHFS). Original ArticleHowever, the optimal approach to management of AHFS with elevated cTn is unknown. Methods and Results-We compared the care and outcomes of 13 656 patients with AHFS seeking care in the emergency department stratified by presence (cTn+, n=1845, 13.5%) or absence (cTn−) of elevated troponin. Clinically abstracted data on patients who were admitted or discharged from the emergency department in Ontario, Canada (

Troponin T in acute heart failure: Clinical implications and prognosis in the Spanish National Registry on Heart Failure

“…Our patients with intermediate or elevated TnT had significantly lower LVEF (and therefore a higher percentage of patients with reduced LVEF) than those with normal TnT, a finding also in line with previous studies [4,6,24,26]. Perna et al and Felker et al observed that these differences were not statistically significant [9,22].…”

“…In the PROTECT study, levels of cardiac TnT N 0.03 ng/mL were confirmed to be an independent predictor of the composite endpoint of cardiovascular/renal rehospitalization or death at 60 days; TnT N 0.01 ng/mL was only predictor on univariate analysis [13]. Finally, Braga et al also reported that elevated troponin was associated with a higher risk of death and cardiovascular hospitalizations at 30, 180 and 365 days [24].…”

Association of Heart-Type Fatty Acid-Binding Protein with Cardiovascular Risk Factors and All-Cause Mortality in the General Population: The Takahata Study

“…Cardiac biomarkers are generally used for the diagnosis or assessment of heart diseases [4], [5], [6], [7]. Recent studies demonstrated that cardiac biomarkers can predict an increased risk for death in subjects in the general population [8], [9].…”

Team-based Care for Patients Hospitalized with Heart Failure

“…Elevated levels of cardiac troponin are often found in patients with HF, [43][44][45][46] many times without any history or other evidence of myocardial ischemia, and even in the absence of coronary artery disease. In patients with HF, the presence of elevated cardiac troponin is associated with increased mortality and worse outcomes.…”