title: Prediction of outcome by highly sensitive troponin T in outpatients with chronic systolic left ventricular heart failure.
abstract: Our aim was to assess the prognostic impact of a high-sensitivity cardiac troponin T (hs-cTnT) assay in an outpatient population with chronic systolic left ventricular heart failure (HF). Four hundred sixteen patients with chronic HF and left ventricular ejection fraction ≤ 45% were enrolled in a prospective cohort study. In addition to hs-cTnT, plasma amino-terminal pro-B-type natriuretic peptide was measured at baseline. Mean age was 71 years, 29% were women, 62% had coronary artery disease (CAD), mean left ventricular ejection fraction was 31%, and 57% had abnormal level of hs-cTnT. During 4.4 years of follow-up, 211 (51%) patients died. In multivariate Cox regression models, hs-cTnT was categorized as quartiles or dichotomized by the 99th percentile of a healthy population. Adjusted hazard ratios for all-cause mortality for quartiles 2 to 4, with quartile 1 as reference, were 1.4 (95% confidence interval 0.9 to 2.4, p = 0.16) for quartile 2, 1.7 (0.9 to 2.5, p = 0.12) for quartile 3, and 2.6 (1.6 to 4.4, p <0.001) for quartile 4 and 1.7 (1.2 to 2.5, p = 0.003) for abnormal versus normal level of hs-cTnT. In patients without CAD, quartile 4 of hs-cTnT was associated with an adjusted hazard ratio of 6.8. In conclusion, hs-cTnT is increased in most outpatients with chronic systolic HF and carries prognostic information beyond clinical parameters and amino-terminal pro-B-type natriuretic peptide. Increased hs-cTnT indicated a particularly deleterious prognosis in patients without CAD.
authors.affiliation: Department of Cardiology and Endocrinology, Frederiksberg University Hospital, Frederiksberg, Denmark. michaelegstrup@dadlnet.dk
authors.forename: Michael
authors.initials: M
authors.lastname: Egstrup
authors.forename: Morten
authors.initials: M
authors.lastname: Schou
authors.forename: Christian D
authors.initials: CD
authors.lastname: Tuxen
authors.forename: Caroline N
authors.initials: CN
authors.lastname: Kistorp
authors.forename: Per R
authors.initials: PR
authors.lastname: Hildebrandt
authors.forename: Finn
authors.initials: F
authors.lastname: Gustafsson
authors.forename: Jens
authors.initials: J
authors.lastname: Faber
authors.forename: Jens-Peter
authors.initials: JP
authors.lastname: Goetze
authors.forename: Ida
authors.initials: I
authors.lastname: Gustafsson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D015331:Cohort Studies; D003324:Coronary Artery Disease / Q000150:complications; D005260:Female; D005500:Follow-Up Studies; D054143:Heart Failure, Systolic / Q000097:blood* / Q000401:mortality / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D011237:Predictive Value of Tests; D015995:Prevalence; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D013318:Stroke Volume / Q000502:physiology; D015996:Survival Rate; D020107:Troponin T / Q000097:blood*; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology*
chemical_list: D020107:Troponin T; D020097:Natriuretic Peptide, Brain