title: [Troponin-T monitoring in outpatients with nonischemic heart failure].
abstract: OBJECTIVE
  The usefulness of prolonged troponin-T (TnT) monitoring in outpatients with nonischemic heart failure (HF) is not clear. The aim of this study was to investigate the incidence, prognostic value and determinants of a raised TnT level.
  
  
  METHODS
  The study involved 80 outpatients (age 56+/-14 years, 69% male) with chronic stable HF (mean left ventricular ejection fraction 24+/-9%; 51 in New York Heart Association class II and 29 in class III) of non-ischemic origin, as confirmed with coronary angiography. The TnT level was measured at study entry and at every outpatient visit (median interval, 3.1 months; interquartile range [IQR], 1.8-5.0 months) in a follow-up period of 22.2+/-10.6 months. Patients were TnT+ if the level was measurable (i.e., >0.01 ng/mL).
  
  
  RESULTS
  At study entry, 7 (9%) patients were TnT+. By 5 years, the cumulative incidence had reached 53%, and the median TnT level was 0.059 ng/mL (IQR, 0.023-0.100 ng/mL; range, 0.013-0.500 ng/mL). Beta-blocker therapy was associated with a reduction in incidence (hazard ratio [HR]=0.220; 95% confidence interval [CI], 0.089-0.540; P=.001) while the incidence increased with the N-terminal probrain natriuretic peptide (NT-proBNP) level (HR=1.005; 95% CI, 1.001-1.010; P=0.021). During follow-up, 14 (17.5%) patients had a cardiac event (i.e., 9 cardiac deaths and 5 urgent transplants); these occurred in 12 (50%) of the 24 TnT+ patients vs. 2 (3.6%) of the 56 TnT- patients (P< .001). After adjustment, Cox multivariate analysis showed that being TnT+ was a predictor of an adverse event (HR per 0.01 ng/mL=1.359; 95% CI, 1.037-1.782; P=.026), independently of the NT-proBNP level (HR per 500 pg/mL=1.057; 95% CI, 1.023-1.092; P=.001).
  
  
  CONCLUSIONS
  A measurable TnT level was frequently observed during clinical monitoring of outpatients with non-ischemic HF and indicated a poor prognosis, even when the level was low.
authors.affiliation: Unidad de Insuficiencia Cardiaca, Servicio de Cardiología, Hospital Universitario Virgen de la Arrixaca, Murcia, España. DomingoA.Pascual@carm.es
authors.forename: Domingo A
authors.initials: DA
authors.lastname: Pascual-Figal
authors.forename: Sergio
authors.initials: S
authors.lastname: Manzano-Fernández
authors.forename: Francisco
authors.initials: F
authors.lastname: Pastor
authors.forename: Iris P
authors.initials: IP
authors.lastname: Garrido
authors.forename: Teresa
authors.initials: T
authors.lastname: Casas
authors.forename: Jesús
authors.initials: J
authors.lastname: Sánchez Mas
authors.forename: Pilar
authors.initials: P
authors.lastname: Ansaldo
authors.forename: Pedro
authors.initials: P
authors.lastname: Martínez
authors.forename: Mariano
authors.initials: M
authors.lastname: Valdés
mesh_terms: D005260:Female; D006333:Heart Failure / Q000097:blood*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D020107:Troponin T / Q000097:blood*
chemical_list: D020107:Troponin T