title: High-sensitivity troponin is associated with high risk clinical profile and outcome in acute heart failure.
abstract: BACKGROUND
  The aim of the study was to evaluate the value of high-sensitivity cardiac troponin (hs-cTn) for identifying high-risk patients.
  
  
  RESULTS
  One hundred and eighty-seven patients admitted with acute heart failure (HF) (without myocardial infarction) were consecutively included; hs-cTn was measured at admission; the relation between elevated hs-cTn and the clinical outcome during hospitalization and at 90 days was analyzed; 93% (n = 174) had hs-cTn above the maximal normal value (14 ng/L); median hs-cTn was 42 ng/L (IQR 24-81). Patients with ejection fraction (EF) ≤ 45% had higher hs-cTn values (p = 0.0004). Patients with low cardiac output syndrome (LCOS) or shock had higher troponin levels compared with those with less severe clinical presentations (p = 0.004). Patients who required inotropic presented higher troponin values (p = 0.002), troponin values were also higher in those requiring complex therapies (intra-aortic balloon pump, mechanical ventilation or hemodialysis, p = 0.002). At 90-day follow-up, 28 (15.5%) patients died and 27 rehospitalizations occurred (55 events). The risk of events was greater in patients with hs-cTn > 42 ng/L (0.021), low blood pressure at admission (p = 0.002), LCOS or shock (p < 0.0001), EF ≤ 45% (p = 0.005) and inotropic use (p < 0.0001). In multivariate analysis, only inotropic agents requirements was associated independently with a high risk of death or rehospitalizations at 90 days (p = 0.007).
  
  
  CONCLUSIONS
  Elevation of hs-cTn is a finding almost constant in patients with decompensated HF. In subjects with higher troponin levels ventricular dysfunction is frequent. The use of hs-cTn for risk stratification at admission helps to identify populations with poor outcome during hospitalization and increased risk of death or rehospitalizations during follow-up who will require rapid implementation of aggressive treatment.
authors.forename: Mirta
authors.initials: M
authors.lastname: Diez
authors.affiliation: Cardiovascular Institute of Buenos Aires. mltalavera@icba.com.ar.
authors.forename: María Luján
authors.initials: ML
authors.lastname: Talavera
authors.forename: Diego Gabriel
authors.initials: DG
authors.lastname: Conde
authors.forename: Roberto
authors.initials: R
authors.lastname: Campos
authors.forename: Adriana
authors.initials: A
authors.lastname: Acosta
authors.forename: Marcelo Sergio
authors.initials: MS
authors.lastname: Trivi
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D001118:Argentina / Q000453:epidemiology; D015415:Biomarkers / Q000097:blood; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D006760:Hospitalization; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D011237:Predictive Value of Tests; D015995:Prevalence; D011379:Prognosis; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D014336:Troponin / Q000097:blood*; D015854:Up-Regulation
chemical_list: D015415:Biomarkers; D014336:Troponin
keywords: decompensated heart failure; high-sensitivity cardiac troponins; mortality (or outcome)