Why the study?
In patients with acute heart failure, definite evidence on the relationship between high-sensitivity cardiac troponin and left ventricular ejection fraction comparing preserved versus reduced ejection fraction was lacking.
Does a positive hs-cTnI test predict adverse outcomes in patients presenting to the ED with acute heart failure without ACS, regardless of LVEF?
Does a positive hs-cTnI test predict adverse outcomes in patients presenting to the ED with acute heart failure without ACS, regardless of LVEF?
In patients with acute heart failure without ACS, elevated hs-cTnI is a reliable biomarker of myocardial injury that predicts adverse ED outcomes (ICU admission or death) regardless of whether LVEF is preserved or reduced.
hs-cTnI positivity may support ED risk stratification in AHF irrespective of LVEF; leaves open need for prospective validation before practice change.
Background and Objectives: In patients with acute heart failure (AHF), there is no definite evidence on the relationship between high-sensitivity cardiac troponin (hs-cTnI) and the left ventricular ejection fraction (LVEF) comparing the reduced and preserved EF conditions. Materials and Methods: Between January and April 2022, we retrospectively analyzed the data from 386 patients admitted to the emergency departments (ED) of five hospitals in Rome, Italy, for AHF. The criteria for inclusion were a final diagnosis of AHF; a cardiac ultrasound and hs-cTnI evaluations in the ED; and age > 18 yrs. We excluded patients with acute coronary syndrome (ACS). Based on echocardiography and hs-cTnI evaluations, the patients were grouped for (1) preserved (HFpEF) or (2) reduced LVEF (HFrEF) and a a) negative (within the normal range value) or b) positive (above the normal range value) of hs-cTnI, respectively. Results: There was a significant negative relationship between a positive test for hs-cTnI and LVEF. When compared to the group with a negative hs-cTnI test, the patients with a positive test, both from the HFpEF and HFrEF subgroups, were significantly more likely to have an adverse outcome, such as being admitted to the intensive care unit (ICU) or dying in the ED. Moreover, a reduced ejection fraction was linked with a final disposition to a higher level of care. Conclusions: In patients admitted to the ED for AHF without ACS, there is a negative relationship between hs-cTnI and a reduced LVEF, although a significant percentage of patients with a preserved LVEF also resulted to have high levels of hs-cTnI. In the absence of ACS, hs-cTnI seems to be a reliable biomarker of myocardial injury in AHF in the ED and should be considered as a risk stratification parameter for these subjects regardless of the left ventricular function. Further larger prospective studies are needed to confirm these preliminary data.
No takes yet. Share an insight, caveat, or question.
Crisanti et al. (2022) studied this question.