“HIGH sensitivity Troponins In Patients With Elevated Pro BNP and Acute Heart Failure”. (HIGH-TRIP Trial)

Background: In patients presented to emergency rooms NT-Pro BNP essay is overly sensitive test to rule out heart failure but less specific in predicting outcomes in follow-ups, in this study we ought to find the added value of HS-Troponin I, in patients presented acutely with heart failure and its impact on mortality when Pro BNP is highly elevated. Methods: Prospective cohort study, inclusion criteria were age above 18 and clearly positive NT Pro BNP > 1000 pg/ml, with 12 months follow up period, primary end point was mortality from heart failure, secondary endpoint was need for rehospitalization. Results: 95 patients were enrolled, divided into overt and non-overt pulmonary edema groups. Mean (NT-Pro BNP) was 6184 and 5927 pg/ml and mean (Hs-c Trop I) were 19.27 and 0.17ng/ml respectively, Mean Ejection fraction was 48+/-7 and 47+/-7 for each group sequentially. Mortality rate was 4 (13%) in the higher Hs-c Troponin I group, and 1 (1.6%) in the low troponin level group p=.03, odd ratio was 8.5, 95% CI (0.9-80). Need for re-hospitalization was present in 12 (38%) Vs 7 (8%) patients, p=.0081, odd ratio 4.8, 95% CI (1.7-14.2). In COX proportional hazard analysis, only Hs-cTN was a significant predictor of poor outcome in this high-risk cohort with p=0.0001. Conclusion: Adding (Hs-cTroponin I) assay to the panel of laboratory testing, in patients presented to ER with acute heart failure and with high Pro-BNP>1000, may further predicts mortality and rehospitalization rate.