Cardiac troponin T for risk stratification in decompensated chronic heart failure.
BACKGROUND
The cardiac troponins are highly sensitive and specific markers of myocardial injury. They have been detected in heart failure (HF) and are associated with a bad prognosis.


OBJECTIVE
To evaluate the association of cardiac troponin T (cTnT) and its ranges with prognosis in decompensated HF.


METHODS
A total of 70 patients with chronic HF worsening that needed hospitalization were studied. Cox model was used to evaluate the variables at admission capable of predicting the combined outcome that consisted of death or re-hospitalization due to HF worsening during a 1-year follow-up.


RESULTS
During the follow-up, there were 44 deaths, 36 re-hospitalizations due to HF and 56 combined outcomes. At the multivariate analysis, the predictors of clinical events were the cTnT (cTnT > or = 0.100 ng/mL; hazard ratio [HR] 3.95 95% confidence interval [CI]: 1.64-9.49, p = 0.002), left ventricular end diastolic diameter (LVDD > or = 70 mm; HR 1.92, 95%CI: 1.06-3.47, p = 0.031) and serum sodium (Na < 135 mEq/L; HR 1.79, 95%CI: 1.02-3.15, p = 0.044). To evaluate the association between the cTnT increase and the prognosis in decompensated HF, the patients were stratified in three groups: low-cTnT (cTnT <0.020 ng/ml, n = 22), intermediate-cTnT (cTnT > 0.020 and < 0.100 ng/ml, n = 36), and high-cTnT (cTnT > or = 0.100 ng/ml, n = 12).The probabilities of survival and event-free survival were 54.2%, 31.5%, 16.7% (p = 0.020) and 36.4%, 11.5%, 8.3% (p = 0.005), respectively.


CONCLUSIONS
The increase in cTnT is associated with a bad prognosis in decompensated HF and the degree of this increase can help the risk stratification.
Del Carlo
Carlos Henrique
CH
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil. dcarlo@cardiol.br
Pereira-Barretto
Antonio Carlos
AC
Cassaro-Strunz
Célia Maria
CM
Latorre
Maria do Rosário Dias de Oliveira
Mdo R
Oliveira Junior
Múcio Tavares
MT
Ramires
José Antonio Franchini
JA
D015415:Biomarkers / Q000097:blood; D002908:Chronic Disease; D004812:Epidemiologic Methods; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D020107:Troponin T / Q000097:blood*
D015415:Biomarkers; D020107:Troponin T