title: Troponin T levels in patients with acute heart failure: clinical and prognostic significance of their detection and release during hospitalisation.
abstract: OBJECTIVE
  Myocardial injury during an episode of acute heart failure (AHF) may be important for patents' outcome. We hypothesised that an increase of cardiac troponin levels (cTnT) during hospitalisation, in patients with undetectable levels on admission (cTnT release), may be a more specific marker of myocardial damage. With this aim, we assessed the clinical and prognostic significance of high serum cTnT levels at the time of admission and that of cTnT release in 198 consecutive patients admitted for AHF and with no signs of acute coronary syndrome.
  
  
  RESULTS
  cTnT levels were serially measured at the time of admission, and after 6 and 12 h, in 198 consecutive patients admitted for AHF and with no signs of acute coronary syndrome. cTnT was detectable (>0.01 ng/mL) in 102 patients (52 %) and positive for myocardial necrosis (>0.03 ng/mL) in 78 patients (39 %). Negative cTnT at the time of admission became positive at 6 and/or 12 h in 36 (18 %) patients. Patients with increased cTnT levels were more likely to have coronary artery disease, hypertension, diabetes, and renal dysfunction. During a median follow-up duration of 247 days (IQR 96-480 days), the detection of increased cTnT levels was associated with a higher rate of all-cause deaths and, for cTnT release, all-cause death and cardiovascular rehospitalisation rate. CTnT release was an independent predictor of all-cause death and cardiovascular rehospitalisation, along with glomerular filtration rate, and the administration of inotropic agents during the initial hospitalisation.
  
  
  CONCLUSIONS
  Increased cTnT levels are a frequent finding in patients with AHF. They are more likely to occur in patients with comorbidities and are associated with poorer outcomes. cTnT release is an independent predictor of poorer outcomes.
authors.affiliation: Cardiology, Department of Experimental and Applied Medicine, University and Civil Hospital of Brescia, c/o Spedali Civili, Piazza Spedali Civili 1, 25123 Brescia, Italy. metramarco@libero.it
authors.forename: Marco
authors.initials: M
authors.lastname: Metra
authors.forename: Luca
authors.initials: L
authors.lastname: Bettari
authors.forename: Franca
authors.initials: F
authors.lastname: Pagani
authors.forename: Valentina
authors.initials: V
authors.lastname: Lazzarini
authors.forename: Carlo
authors.initials: C
authors.lastname: Lombardi
authors.forename: Valentina
authors.initials: V
authors.lastname: Carubelli
authors.forename: Graziella
authors.initials: G
authors.lastname: Bonetti
authors.forename: Silvia
authors.initials: S
authors.lastname: Bugatti
authors.forename: Giovanni
authors.initials: G
authors.lastname: Parrinello
authors.forename: Luigi
authors.initials: L
authors.lastname: Caimi
authors.forename: G Michael
authors.initials: GM
authors.lastname: Felker
authors.forename: Livio
authors.initials: L
authors.lastname: Dei Cas
mesh_terms: D000208:Acute Disease; D015415:Biomarkers / Q000097:blood; D015897:Comorbidity; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000175:diagnosis* / Q000401:mortality*; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D017682:Myocardial Stunning / Q000097:blood / Q000175:diagnosis* / Q000401:mortality*; D010351:Patient Discharge / Q000706:statistics & numerical data*; D015995:Prevalence; D011379:Prognosis; D015203:Reproducibility of Results; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D015996:Survival Rate; D020107:Troponin T / Q000097:blood*
chemical_list: D015415:Biomarkers; D020107:Troponin T