Key result
Rising or stable high-sensitive cardiac troponin T levels at hospital discharge independently predicted an increased risk of heart failure-related rehospitalization (HR 1.69) compared to falling levels.
Cohort (n=404)
No
Hazard Ratio: 1.69 (95% CI 1.06–2.7)
p-value: p=0.03
In patients with acute decompensated heart failure, a rising or stable high-sensitivity cardiac troponin T level at discharge is a significant independent predictor of heart failure-related rehospitalization.
May aid discharge risk stratification in ADHF; leaves open whether troponin trajectories should guide therapy.
BACKGROUND: High-sensitive cardiac troponin T (hsTnT) is a sensitive biomarker of myocardial damage and predictor of acute decompensated heart failure (ADHF). However, there is little information on changes over time in hsTnT level during ADHF management. The aim of this prospective study was to evaluate changes in hsTnT levels between admission and at discharge in patients with ADHF, and identify factors that determine such levels and their prognostic significance. METHODS AND RESULTS: We evaluated 404 ADHF patients with abnormal hsTnT levels (≥0.0135 ng/ml) on admission. The median (interquartile ranges) hsTnT levels on admission, at discharge, and percent changes in hsTnT levels were 0.038 (0.026 to 0.065), 0.032 (0.021 to 0.049) ng/ml, and -12.0 (-39.8 to 7.4) % respectively. The numbers of patients with falling (hsTnT decrease > -15%), stable (hsTnT change between -15 and +15%) and rising (hsTnT increase > +15%) hsTnT level at discharge were 190, 146, and 68, respectively. The percent change in B-type natriuretic peptide (BNP) levels was greater in the falling group, compared to the stable (p<0.001) and rising groups (p<0.001). Changes in hsTnT levels correlated significantly with changes in BNP levels (ρ = 0.22, p<0.001). Multivariate Cox regression analysis identified rising or stable hsTnT at discharge as a significant predictor of heart failure-related rehospitalization (hazard ratio: 1.69; 95% confidence interval: 1.06 to 2.70; p = 0.03). CONCLUSIONS: Persistent increase in hsTnT levels at discharge correlated with inadequate decrease of BNP levels, and was a predictor of poor clinical outcome, with repeat heart failure hospitalizations.
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Takashio et al. (2017) conducted a cohort in Acute decompensated heart failure (n=404). Rising or stable high-sensitive cardiac troponin T (hsTnT) levels at discharge vs. Falling hsTnT levels at discharge (decrease > 15%) was evaluated on Heart failure-related rehospitalization (HR 1.69, 95% CI 1.06 to 2.70, p=0.03). Rising or stable high-sensitive cardiac troponin T levels at hospital discharge independently predicted an increased risk of heart failure-related rehospitalization (HR 1.69) compared to falling levels.
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