Serial Measurement of Cardiac Troponin T Using a Highly Sensitive Assay in Patients With Chronic Heart Failure

Abstract

on behalf of the Valsartan Heart Failure Trial (Val-HeFT) and Gruppo Italiano per lo Studio della Sopravvivenza nell'Insufficienza Cardiaca-Heart Failure (GISSI-HF) InvestigatorsBackground-Cardiac troponins are emerging as important prognostic markers in chronic cardiovascular conditions like stable coronary artery disease or chronic heart failure (HF). Less is known about the relation between serial measurements of high-sensitivity cardiac troponin T (hs-cTnT) and future events in HF. We determined the association between changes over time in hs-cTnT and outcome in patients with chronic HF. Methods and Results-We analyzed 5284 patients with chronic HF from 2 independent randomized clinical trials, the Valsartan Heart Failure Trial (Val-HeFT) (nϭ4053) and the Gruppo Italiano per lo Studio della Sopravvivenza nell'Insufficienza Cardiaca-Heart Failure (GISSI-HF) trial (nϭ1231). hs-cTnT was measured at randomization and after 3 months (GISSI-HF) or 4 months of follow-up (Val-HeFT). The association between changes over time of hs-cTnT and various outcomes was tested in multivariable models. In both studies, increases in hs-cTnT levels over time were associated with age, diabetes mellitus, worsening of renal function (reduction in estimated glomerular filtration rate), and baseline and increases in N-terminal pro-brain natriuretic peptide concentrations. Increases in hs-cTnT concentrations were associated with all-cause mortality (incidence rates, 8.19 [7.51-8.88 Key Words: biomarkers Ⅲ heart failure Ⅲ natriuretic peptides Ⅲ prognosis Ⅲ troponin T V ery low circulating levels of troponin are detectable in the general population with the new generation of highly sensitive assays and are associated with adverse cardiovascular outcomes. [1][2][3] Besides acute myocardial infarction, elevated troponin levels are also reported in several chronic disease states like coronary artery disease, 4,5 diabetes mellitus, 6 or chronic kidney disease. 7 Troponin release in the bloodstream is low in patients with stable chronic heart failure (HF) and predicts adverse outcomes. 8,9 The mechanisms of troponin release in chronic HF are not entirely clear and not only may reflect ongoing cardiac myocyte damage but also may be related to noncardiac causes such as pulmonary disease or chronic renal insufficiency that are not infrequent comorbidities in HF. 10,11 Received May 24, 2011; accepted November 18, 2011 Clinical Perspective on p 288The increased sensitivity of the newly developed assays for cardiac troponins comes at the cost of decreased specificity, making clinical judgment more important in the interpretation of troponin assay results. 12 Although baseline high-sensitivity cardiac troponin T (hs-cTnT) levels are strong predictors of adverse outcome, a few studies suggest that changes in hs-cTnT levels over time may convey additional prognostic information compared with a single measurement. 2 In this report, we present the results from 2 large multicenter randomized clinical trials (Valsartan Heart Failure Trial [Val-HeFT] and...

Rehospitalization for Heart Failure

“…Levels of cardiac biomarkers including natriuretic peptides and cardiac troponins may also anticipate readmission risk, particularly if they remain high at hospital discharge. [22][23][24][25][26] Indicators of neurohormonal activation, including higher levels of circulating catecholamines and reninangiotensin system metabolites or lower levels of serum sodium, can also identify patients at risk. Increasing diuretic requirements or intolerance of neurohormonal antagonists because of hypotension or renal dysfunction 27 are likely indicators of disease progression and accordingly track with worsening clinical outcomes.…”

Application of Cardiac Troponin in Cardiovascular Diseases Other Than Acute Coronary Syndrome

“…In a pooled analysis of patients from the Val-HeFT and GISSI-HF trials (n ϭ 5284), patients with a Ͼ15% increase in cTnT concentrations over a 3-4 months period had a significantly increased all-cause and HF-related mortality (56 ). Data from other studies support these results (57,58 ).…”

Molecular Biomarkers for Diagnostics, Risk Stratification and Prediction of Chronic Heart Failure

“…При анализе данных 5284 пациентов из исследований Val-HeFT и GISSI-HF было дока-зано независимое прогностическое значение вч-Тро-понина как важного предиктора неблагоприятных сердечно-сосудистых событий у пациентов с хрони-ческой СН [42].…”