In outpatients with advanced CHF, an increasing number of abnormal cTnT samples predicted worse prognosis (HR 1.6; 95% CI 1.1-2.4), with 18-month hospitalization-free survival of 17% vs 63%.
Cohort (n=115)
Do abnormal serial cardiac troponin T (cTnT) concentrations predict worsening heart failure and hospitalization-free survival in outpatients with severe chronic heart failure?
Serial detection of abnormal cTnT concentrations in outpatients with advanced heart failure is a strong independent predictor of worsening CHF and reduced hospitalization-free survival.
Effect estimate: HR 1.6 (95% CI 1.1 to 2.4)
Absolute Event Rate: 17% vs 63%
p-value: p=0.0001
BACKGROUND: The progression of chronic heart failure (CHF) is related to ongoing myocyte loss, which can be detected by cardiac troponin T (cTnT). We examined the prevalence and prognostic value of increased cTnT concentrations in serial blood specimens from patients with severe CHF. METHODS AND RESULTS: Clinical, echocardiographic, and 6-minute walk test data were collected prospectively at baseline and at 1 year in 115 outpatients (mean age, 61+/-11 years; 75% men; 62% coronary heart disease) with CHF and a left ventricular ejection fraction or =0.02 ng/mL were considered abnormal, and a Tn index (highest cTnT measurement/0.02 ng/mL) was calculated. In 62 patients (54%), cTnT was consistently or =2 abnormal cTnT results (group 3). At 18 months, CHF hospitalization-free survival was 63%, 46%, and 17%, respectively (P=0.0001). In a Cox proportional-hazards model, hospitalization for worsening CHF in the previous year (HR=2.1; 95% CI, 1.1 to 4.1), functional class III-IV (HR=2.3; 95% CI, 1.1 to 4.6), and number of abnormal cTnT samples (HR=1.6; 95% CI, 1.1 to 2.4) were independently associated with prognosis. A cTnT rise of 0.020 ng/mL in any sample was associated with an excess of 9% (95% CI, 1% to 18%) in the incidence of combined end point. CONCLUSIONS: Abnormal cTnT concentrations were detected in >50% of outpatients with advanced CHF. This ongoing myocardial necrosis was a strong predictor of worsening CHF, suggesting a role of cTnT-based monitoring to identify high-risk patients.
Perna et al. (2004) conducted a cohort in severe chronic heart failure (n=115). Abnormal cTnT concentrations (≥0.02 ng/mL) vs. Consistently normal cTnT (<0.02 ng/mL) was evaluated on CHF hospitalization-free survival at 18 months (HR 1.6, 95% CI 1.1 to 2.4, p=0.0001). In outpatients with advanced CHF, an increasing number of abnormal cTnT samples predicted worse prognosis (HR 1.6; 95% CI 1.1-2.4), with 18-month hospitalization-free survival of 17% vs 63%.