title: Minor myocardial damage is a prevalent condition in patients with acute heart failure syndromes and preserved systolic function with long-term prognostic implications: a report from the CIAST-HF (Collaborative Italo-Argentinean Study on cardiac Troponin T in Heart Failure) study.
abstract: BACKGROUND
  Half of patients with acute heart failure syndromes (AHFS) have preserved left ventricular ejection fraction (PLVEF). In this setting, the role of minor myocardial damage (MMD), as identified by cardiac troponin T (cTnT), remains to be established.
  
  
  OBJECTIVE
  To evaluate the prevalence and long-term prognostic significance of cTnT elevations in patients with AHFS and PLVEF.
  
  
  METHODS
  This retrospective, multicenter, collaborative study included 500 patients hospitalized for AHFS with PLVEF (ejection fraction ≥40%) between October 2000 and December 2006. Blood samples were collected within 12 hours after admission and were assayed for cTnT. MMD was defined as a cTnT value of ≥0.020 ng/mL.
  
  
  RESULTS
  Mean age was 73 ± 12 years, 47% were female, 38% had an ischemic etiology, and New York Heart Association (NYHA) class was 2.2 ± 0.7. Mean cTnT value was 0.149 ± 0.484 ng/mL, and cTnT was directly correlated with serum creatinine (Spearman's Rho = 0.35, P < .001) and NYHA class (0.25, P < .001). MMD was diagnosed in 220 patients (44%). Patients with MMD showed lower left ventricular ejection fraction (P < .05), higher serum creatinine (P < .001), higher prevalence of ischemic etiology and diabetes mellitus, a worse NYHA class (P < .001), and higher natriuretic peptide levels (P < .001) as compared with patients without MMD. At 6-month follow-up, overall event-free survival was 55% and 75% in patients with and without MMD (P < .001), respectively. On multivariate Cox regression analysis, only NYHA class (HR = 1.50; P = .002) and MMD (HR = 1.81; P = .001) were identified as predictors of events.
  
  
  CONCLUSIONS
  Increased cTnT levels were detected in approximately 50% of patients with AHFS with preserved systolic function, and were found to correlate with clinical measures of disease severity. The presence of MMD was associated with a worse long-term outcome, lending support to cTnT-based risk stratification in the setting of AHFS.
authors.affiliation: Heart Failure Clinic, Coronary Intensive Care Unit, Instituto de Cardiologia "Juana F. Cabral", Corrientes, Argentina. pernaucic@hotmail.com
authors.forename: Eduardo R
authors.initials: ER
authors.lastname: Perna
authors.forename: Nadia
authors.initials: N
authors.lastname: Aspromonte
authors.forename: Juan P
authors.initials: JP
authors.lastname: Cimbaro Canella
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Di Tano
authors.forename: Stella M
authors.initials: SM
authors.lastname: Macin
authors.forename: Mauro
authors.initials: M
authors.lastname: Feola
authors.forename: María L
authors.initials: ML
authors.lastname: Coronel
authors.forename: Loredano
authors.initials: L
authors.lastname: Milani
authors.forename: Jorge I
authors.initials: JI
authors.lastname: Parras
authors.forename: Massimo
authors.initials: M
authors.lastname: Milli
authors.forename: Edgar H
authors.initials: EH
authors.lastname: García
authors.forename: Roberto
authors.initials: R
authors.lastname: Valle
mesh_terms: D054058:Acute Coronary Syndrome / Q000453:epidemiology / Q000378:metabolism / Q000503:physiopathology; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001118:Argentina / Q000453:epidemiology; D003299:Cooperative Behavior; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000453:epidemiology* / Q000378:metabolism / Q000503:physiopathology*; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000378:metabolism* / Q000473:pathology*; D011237:Predictive Value of Tests; D015995:Prevalence; D011379:Prognosis; D012189:Retrospective Studies; D013577:Syndrome; D013599:Systole / Q000502:physiology*; D013995:Time; D020107:Troponin T / Q000096:biosynthesis / Q000378:metabolism*; D055815:Young Adult
chemical_list: D020107:Troponin T