Ongoing myocardial injury in stable severe heart failure: value of cardiac troponin T monitoring for high-risk patient identification.
BACKGROUND
The progression of chronic heart failure (CHF) is related to ongoing myocyte loss, which can be detected by cardiac troponin T (cTnT). We examined the prevalence and prognostic value of increased cTnT concentrations in serial blood specimens from patients with severe CHF.


RESULTS
Clinical, echocardiographic, and 6-minute walk test data were collected prospectively at baseline and at 1 year in 115 outpatients (mean age, 61+/-11 years; 75% men; 62% coronary heart disease) with CHF and a left ventricular ejection fraction <40%. Blood samples were collected at baseline and at 3, 6, and 12 months of follow-up. cTnT concentrations > or =0.02 ng/mL were considered abnormal, and a Tn index (highest cTnT measurement/0.02 ng/mL) was calculated. In 62 patients (54%), cTnT was consistently <0.02 ng/mL (group 1); 28 (24%) had a single abnormal cTnT result (group 2); and 25 (22%) had > or =2 abnormal cTnT results (group 3). At 18 months, CHF hospitalization-free survival was 63%, 46%, and 17%, respectively (P=0.0001). In a Cox proportional-hazards model, hospitalization for worsening CHF in the previous year (HR=2.1; 95% CI, 1.1 to 4.1), functional class III-IV (HR=2.3; 95% CI, 1.1 to 4.6), and number of abnormal cTnT samples (HR=1.6; 95% CI, 1.1 to 2.4) were independently associated with prognosis. A cTnT rise of 0.020 ng/mL in any sample was associated with an excess of 9% (95% CI, 1% to 18%) in the incidence of combined end point.


CONCLUSIONS
Abnormal cTnT concentrations were detected in >50% of outpatients with advanced CHF. This ongoing myocardial necrosis was a strong predictor of worsening CHF, suggesting a role of cTnT-based monitoring to identify high-risk patients.
Heart Failure Clinic, Instituto de Cardiología Juana F. Cabral, Bolívar 1334, Corrientes, 3400, Argentina. pernaucic@hotmail.com
Eduardo R
ER
Perna
Stella M
SM
Macin
Juan P Cimbaro
JP
Canella
Natalia
N
Augier
Jorge L Riera
JL
Stival
Jorge R
JR
Cialzeta
Ariel E
AE
Pitzus
Edgar H
EH
Garcia
Ricardo
R
Obregón
Mónica
M
Brizuela
Alejandro
A
Barbagelata
D000368:Aged; D015415:Biomarkers; D016923:Cell Death; D003327:Coronary Disease / Q000150:complications; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000473:pathology / Q000503:physiopathology; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D015993:Life Tables; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology*; D032383:Myocytes, Cardiac / Q000473:pathology; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D016896:Treatment Outcome; D020107:Troponin T / Q000097:blood*
D015415:Biomarkers; D020107:Troponin T