October 31, 2012
View Full PaperPrognostic value of cardiac troponin in chronic stable heart failure: a systematic review
Key Result
Elevated baseline cardiac troponin in chronic stable heart failure was associated with a higher risk of mortality (HR 2.85; 95% CI 2.02-4.03) and combined adverse cardiovascular outcomes.
Key Points
- To investigate the prognostic value of different types of cardiac troponins in chronic stable heart failure.
- Systematic review of literature from PubMed, Cochrane Library, and Web of Science up to April 2012.
- Included studies assessed prognosis based on baseline cardiac troponin levels in chronic stable heart failure patients.
- Data extraction was performed by two authors who reviewed characteristics and outcomes of the included studies.
- 16 out of 365 identified papers were included in the analysis.
- Elevated cardiac troponin levels associated with a high risk of mortality (HR 2.85; 95% CI 2.02 to 4.03).
- No significant difference in prognostic value was found between high-sensitivity and low-sensitivity assays (p=0.54).
Study Design
Type
Systematic Review
Structured PICO
Does elevated baseline cardiac troponin predict mortality and adverse cardiovascular outcomes in adults with chronic stable heart failure?
P
Population
Systematic review of 16 studies assessing the prognostic value of elevated baseline cardiac troponin in adults with chronic stable heart failure.
E
Exposure
Elevated baseline cardiac troponin (including low and high sensitivity assays)
C
Comparator
Non-elevated baseline cardiac troponin
O
Outcome
Mortality and combined adverse cardiovascular outcomehard clinical
Elevated baseline cardiac troponin, regardless of assay sensitivity, identifies patients with chronic stable heart failure at higher risk of mortality and adverse cardiovascular outcomes.
Main Result
Hazard Ratio: 2.85 (95% CI 2.02–4.03)
Abstract
CONTEXT: Cardiac troponins have become the 'gold standard' for diagnosing myocardial infarction. Elevation of cardiac troponins is noted in patients with chronic stable heart failure, but comparative prognostic value of different assay types is not established. OBJECTIVE: To perform a systematic review for investigating the prognostic value of the different types of cardiac troponins (including low and high sensitivity) in chronic stable heart failure. DATA SOURCES: Search of three databases, PubMed, The Cochrane Library and Web of Science, was made in April 2012. STUDY SELECTION: All studies which provided information on prognosis based upon the baseline cardiac troponin elevation in chronic stable heart failure were included. Limits applied were adults, humans and English language. DATA EXTRACTION: Two authors individually reviewed all studies and extracted data on patient and study characteristics along with primary and secondary outcomes. RESULTS: 16 of the 365 papers from three databases were finally included for data analysis. Elevated baseline cardiac troponin in patients with chronic stable heart failure was associated with a high risk of mortality (HR 2.85; 95% CI 2.02 to 4.03) and combined adverse cardiovascular outcome (HR 2.38; 95% CI 1.63 to 3.49). Although high-sensitivity assay detected cardiac troponin in higher proportion of patients compared with low-sensitivity assay, there was no statistically significant difference among both groups (p=0.54). CONCLUSIONS: Elevated baseline cardiac troponin level identified chronic stable heart failure patients who are at a higher risk of mortality and combined adverse cardiovascular outcomes. There was no statistically significant difference between high- and low-sensitivity cardiac troponins.