Minor myocardial damage detected by troponin T is a powerful predictor of long-term prognosis in patients with acute decompensated heart failure.
BACKGROUND
The progression of chronic heart failure (CHF) is characterized by frequent exacerbation requiring hospitalization and high mortality. Clinical deterioration is triggered by many factors that could promote ongoing myocytes injury. We sought to determine whether a specific marker of cardiac injury, troponin T (cTnT), is associated with prognosis in acute decompensated heart failure (ADHF).


METHODS
One hundred and eighty-four consecutive patients with ADHF were enrolled in the absence of an acute coronary syndrome. A cTnT value> or =0.1 ng/ml in samples drawn at 6, 12 or 24 h after hospital admission was considered abnormal.


RESULTS
Increased levels of cTnT were found in 58 patients (31.5%, group 1). There were no significant differences between group 1 and patients with cTnT<0.1 ng/ml (group 2) in terms of demographic and clinical characteristics, although ischemic etiology was more prevalent in group 1 (51.7% vs. 31.7%, p=0.009). During follow-up, the mortality in groups 1 and 2 was 31% and 17.5% (p=0.038, OR=2.13, 95% CI: 1.03-4.69), respectively. The 3-year free-CHF readmission survival in group 1 and 2 was 25% and 53% (log rank test p=0.015). In a Cox proportional hazard model, poor tissue perfusion (HR=2.46, 95% CI=1.31-4.6), previous infarction (HR=1.99, 95% CI=1.02-3.9) and cTnT> or =0.1 ng/ml (HR=1.74, 95% CI=1.05-2.9) emerged as the independent predictors of long-term outcome.


CONCLUSIONS
One third of patients with decompensated CHF had elevated levels of cTnT. Troponin T was an independent long-term prognostic marker of morbidity and mortality and it suggests a role of biochemical risk stratification in this setting.
Perna
Eduardo R
ER
Heart Failure Clinic, Coronary Intensive Care Unit, Instituto de Cardiología "Juana F. Cabral", Bolivar 1334, Corrientes 3400, Argentina. pernaucic@hotmail.com
Macín
Stella M
SM
Cimbaro Canella
Juan P
JP
Alvarenga
Pablo M
PM
Ríos
Nelson G
NG
Pantich
Rolando
R
Augier
Natalia
N
Farías
Eduardo F
EF
Jantus
Eloísa
E
Brizuela
Monica
M
Medina
Fernanda
F
D000208:Acute Disease; D000368:Aged; D018450:Disease Progression; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000150:complications / Q000401:mortality; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000097:blood* / Q000209:etiology / Q000503:physiopathology; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D020107:Troponin T / Q000097:blood*; D016277:Ventricular Function, Left / Q000502:physiology
D020107:Troponin T