title: Cardiac troponin T for risk stratification in decompensated chronic heart failure.
abstract: 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.
authors.affiliation: Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil. dcarlo@cardiol.br
authors.forename: Carlos Henrique
authors.initials: CH
authors.lastname: Del Carlo
authors.forename: Antonio Carlos
authors.initials: AC
authors.lastname: Pereira-Barretto
authors.forename: Célia Maria
authors.initials: CM
authors.lastname: Cassaro-Strunz
authors.forename: Maria do Rosário Dias de Oliveira
authors.initials: Mdo R
authors.lastname: Latorre
authors.forename: Múcio Tavares
authors.initials: MT
authors.lastname: Oliveira Junior
authors.forename: José Antonio Franchini
authors.initials: JA
authors.lastname: Ramires
mesh_terms: 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*
chemical_list: D015415:Biomarkers; D020107:Troponin T