Serial high sensitivity cardiac troponin T measurement in acute heart failure: insights from the RELAX‐AHF study

Abstract

Aims Troponin elevation is common in acute heart failure (AHF) and may be useful for prognostication; however, available data are mixed and many previous studies used older, less sensitive assays. We examined the association between serial measurements of high‐sensitivity cardiac troponin T (hs‐cTnT) and outcomes in RELAX‐AHF. Methods and results Hs‐cTnT was measured at baseline and days 2, 5, and 14. We assessed the relationship between baseline, peak and peak change hs‐cTnT with dyspnoea relief by visual analogue scale, cardiovascular death, or HF/renal hospitalization to 60 days and cardiovascular mortality to 180 days. Models were adjusted for clinical variables and treatment assignment. Whether baseline troponin status affected the treatment effect of serelaxin was assessed using interactions terms. In 1074 patients, the median baseline troponin was 0.033 µg/L, and 90% of patients were above the 99th upper reference limit (URL). Patients with hs‐cTnT >median were more likely to be men with ischaemic heart disease, worse renal function, and higher N‐terminal pro‐brain natriuretic peptide. Higher baseline or peak hs‐cTnT and greater peak change were associated with worse outcomes independent of adjustment for covariates, but relationships were generally strongest for 180‐day cardiovascular mortality (hazard ratio per doubling of baseline hs‐cTnT = 1.36, 95% confidence interval 1.15–1.60). Troponin was most strongly associated with death from heart failure or from other cardiovascular causes. The treatment effect of serelaxin did not differ by baseline troponin levels. Conclusion Hs‐cTnT was elevated above the 99% URL in the majority of AHF patients. Baseline, peak, and peak change hs‐cTnT were associated with worse outcomes, with the strongest relationship with 180‐day cardiovascular mortality.

ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012

“…However, elevated concentrations of circulating cardiac troponins are detected in the vast majority of patients with AHF, often without obvious myocardial ischaemia or an acute coronary event, suggesting ongoing myocyte injury or necrosis in these patients. 525 Also in patients with acute pulmonary embolism as the underlying cause of acute decompensation, elevated troponins are useful for risk stratification and decision-making.…”

High-Sensitivity Troponin in the Triage of Acute Decompensated Heart Failure ∗

“…In the RELAX-AHF-1 (RELAXin in Acute Heart Failure) trial of patients with ADHF randomized to serelaxin or placebo, the great majority of patients (>90%) had high-sensitivity cardiac troponin T (hsTnT) levels >99th percentile upper reference limit of 14 ng/l (0.014 mg/l), with an increasing gradient of risk of cardiovascular death and rehospitalization for HF with higher concentrations above that threshold (7). The authors' present analysis focuses on 107 patients (9.9% of the cohort) with hsTnT <14 ng/l.…”

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

“…Patients with persistently increased cardiac troponin, measured at multiple time points during or following their hospitalization, had worse clinical outcomes compared to those without similar increases in cardiac troponin. Conversely, stable or decreasing cardiac troponin concentrations were associated with lower rates of adverse clinical outcomes (16,17 ).…”