Increased levels of cardiac troponin-T in outpatients with heart failure and preserved systolic function are related to adverse clinical findings and outcome

Macin, Stella M.; Perna, Eduardo R.; Canella, Juan P. Címbaro; Augier, Natalia; Stival, Jorge L. Riera; Cialzeta, Jorge; Pitzus, Ariel E.; Obregón, Ricardo; García, Edgar; Medina, Fernanda; Badaracco, R.

doi:10.1097/01.mca.0000236287.56435.14

Cited by 13 publications

(5 citation statements)

References 36 publications

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“…Furthermore, once LVEF is low, the risk of dying is so high that TnT modifies it only slightly. In previous studies of patients with preserved LVEF, mortality and HF readmissions were significantly higher in the patients with increased TnT [21,27]. However, in the study reported by Kutsuzawa, TnT did not predict cardiovascular events in patients with preserved LVEF, probably because the sample was small [28].…”

Section: Discussioncontrasting

confidence: 46%

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

Espartero¹,

Salamanca‐Bautista²,

Aramburu‐Bodas³

et al. 2014

European Journal of Internal Medicine

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Section: Discussioncontrasting

confidence: 46%

“…Perna et al and Felker et al observed that these differences were not statistically significant [9,22]. It is remarkable that 67.9% of our patients had preserved LVEF, since most studies where the prognostic value of troponin is analyzed mostly include patients with reduced LVEF [6] and series of preserved LVEF are usually small [27].…”

Section: Discussionmentioning

confidence: 90%

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

Espartero¹,

Salamanca‐Bautista²,

Aramburu‐Bodas³

et al. 2014

European Journal of Internal Medicine

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“…(17) It may also result from increased apoptosis in heart failure,(5) thus representing increased cardiomyocyte turnover which may be indicative of progressive myocardial dysfunction. In heart failure patients, circulating cTn levels have prognostic value independent of renal function (18) and natriuretic peptide levels,(19) in either heart failure with reduced or preserved left ventricular ejection fraction,(20) and in the elderly. (11)…”

Section: Discussionmentioning

confidence: 99%

Prognostic Comparison of Different Sensitivity Cardiac Troponin Assays in Stable Heart Failure

Grodin¹,

Neale²,

Wu³

et al. 2015

The American Journal of Medicine

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Background Cardiac troponin levels offer prognostic information for patients with heart failure. Highly sensitive assays detect levels of cTn much lower than the 99th percentile of standard cTn assays. We hypothesize that cardiac troponin (cTn) levels measured by a high sensitivity assay provide better prognostic value compared to cTn levels measured by a standard assay in patients with chronic heart failure. Methods We measured high sensitivity cTnT (hs-cTnT) and standard cTnI levels, as well as aminoterminal pro B-type natriuretic peptide (NT-proBNP) in 504 sequential stable patients with a history of heart failure who underwent elective coronary angiography, without acute coronary syndrome, and with 5-year follow-up of all-cause mortality. Results The median hs-cTnT level was 21.2 [interquartile range 12.3, 40.9] ng/L and 170 subjects died over 5-years. In a head-to-head overall comparison, hs-cTnT provided increased prognostic utility compared to cTnI (area under the curve [AUC] 66.1% and AUC 69.4%, respectively, p=0.03; 9.0% integrated discrimination improvement, p<.001; and 13.6% event-specific reclassification, p<.001), and was independent of NT-proBNP and renal function. Even within the subset of patients where cTn levels by both assays were above the limit of quantification, higher hs-cTnT is associated with a 2-fold increase in 5-year mortality risk after adjusting for traditional risk factors (tertile 1 vs. 3: Hazard ratio [95% confidence interval] 2.0 [1.3-3.2]; p=0.0002). Conclusion Cardiac troponin can be detected by the high sensitivity assay in more patients with chronic heart failure than the standard assay, and may yield independent and better prognostic accuracy for mortality prediction than standard assay.

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“…Increased BNP or NT-proBNP identifi es patients with elevated LV end-diastolic pressures but does not differentiate patients with preserved LVEF from those with reduced LVEF [8]. Troponin levels are also reported to be high in HF-PEF patients [9] and correlate with clinical measures of disease severity and poor outcome. Other testing: Cardiopulmonary exercise testing may be useful in identifying pulmonary causes, especially in patients with mixed cardiopulmonary disease.…”

Section: Diagnosismentioning

confidence: 99%

Treatment of patients with heart failure and preserved ejection fraction

Deswal¹,

Bozkurt

2008

Curr Treat Options Cardio Med

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Of the more than 5 million Americans who have heart failure (HF), 30% to 50% have HF with preserved ejection fraction (HF-PEF). HF-PEF commonly occurs in elderly patients, especially women, with comorbidities of hypertension, left ventricular hypertrophy, diabetes, myocardial ischemia, and obesity. HF-PEF is associated with high morbidity and mortality. Although two large multicenter randomized, placebo-controlled trials evaluating an angiotensin-converting enzyme inhibitor (ACEI) and an angiotensin receptor blocker (ARB) in patients with HF-PEF did not demonstrate any statistically significant benefit in their primary end points, they did suggest that these agents may have a modest role in reducing HF hospitalizations. Although calcium channel blockers and beta-blockers may be of benefit in patients with HF-PEF, large clinical trial data are not available to support their routine use in all patients with HF-PEF. Subgroup analysis does not support the use of digoxin in patients with HF-PEF in sinus rhythm. Current therapeutic recommendations for HF-PEF are aimed at 1) management of HF symptoms with sodium and fluid restriction along with diuretics for volume overload and 2) treatment of concomitant comorbidities, especially hypertension, rate and possibly rhythm control of atrial fibrillation, and evaluation and treatment of myocardial ischemia and anemia. ACEIs, ARBs, calcium channel blockers, and beta-blockers are recommended for HF-PEF patients who have other established indications for their use. Results are awaited from ongoing clinical trials with another ARB, irbesartan, and an aldosterone blocker, spironolactone.

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Increased levels of cardiac troponin-T in outpatients with heart failure and preserved systolic function are related to adverse clinical findings and outcome

Cited by 13 publications

References 36 publications

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

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

Prognostic Comparison of Different Sensitivity Cardiac Troponin Assays in Stable Heart Failure

Treatment of patients with heart failure and preserved ejection fraction

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