Troponin as a prognostic risk factor in patients hospitalized for decompensation of chronic systolic heart failure

Česká verzia

Authors: R. Štípal jr.; O. Ludka; V. Musil; Z. Pozdíšek; J. Jarkovský ; J. Špinar
Published in the journal: Kardiol Rev Int Med 2012, 14(3): 182-189
Category:

Summary

Background:
The significance of evaluation of cardiac troponins is associated mainly with diagnostics of acute coronary syndromes. An increasing number of evidences of the significance of evaluation of cardiac enzymes as markers of myocardial damage even in acute heart failure have been observed lately. Elevation of cardiac troponins suggests presence of damage or death of myocytes, which is considered to be the main mechanism of development of myocardial dysfunction and acute decompensated heart failure. The current guidelines for diagnostics and treatment of acute heart failure do not mention routine examination of troponin. However, recently published data point out the significance of examination of cardiac troponins as a useful prognostic indicator for risk stratification of patients, both in patients with ischaemic and in patients with non-ischaemic aethiology of their heart failure.

Objective:
To determine the incidence of troponin-T positivity in patients hospitalized for acute decompensated chronic systolic heart failure without evidence of acute coronary syndrome according to guidelines of the Czech Society of Cardiology, and also to find out whether the troponin-T positivity, apart from the effect on short-term mortality, is also related to long--term prognosis in these patients.

Methods:
Prospective, single-centre study focused on non-invasive prognostic markers in acute heart failure; troponin-T being determined on admission with control examination after 12 hours. Cohort: 55 patients, 71% male, 29% female, aged 68 years, body mass index 27.4 kg/m², aetiology of chronic heart failure – 73% ischaemic heart disease, 15 % dilated cardiomyopathy, 12 % other, NYHA classification in long-term history I/II/III – 32.7/56.4/10.9%, on admission – swelling of lower limbs 49.1%, rales 87.3%, orthopnoea 58.2%, BNP on admission 1,090 pg/ml, on discharge 429 pg/ml, LVEF 27.0%, length of hospitalization 10 days.

Results:
troponin-T positive – 45 (81.8%) patients, troponin-T negative – 10 (18.2%) patients. Maximum troponin-T value is a positive risk factor for the overall (p = 0.032) and cardiovascular (p = 0.029) mortality. Cut-off value for patient’s risk of death is 0.03 µg/l (follow-up of 17 months).

Conclusion:
In most of the patients hospitalized for acute decompensated chronic systolic heart failure we have proved increase in troponin-T; troponin positivity is a valuable marker for estimation of prognosis in patients with chronic systolic heart failure and their risk stratification.

Keywords:
heart failure – prognosis – troponin – natriuretic peptides

Supported by grant Ministry of Health Czech Republic 10422-3/2009.

Zdroje

1. Kociol RD, Pang PS, Gheorghiade M et al. Troponin elevation in heart failure: prevalence, mechanisms, and clinical implications. J Am Coll Cardiol 2010; 56: 1071–1078.

2. Peacock WF 4th, De Marco T, Fonarow GC et al. ADHERE Investigators. Cardiac troponin and outcome in acute heart failure. N Engl J Med 2008; 358: 2117–2126

3. Arenja N, Reichlin T, Drexler B et al. Sensitive cardiac troponin in the diagnosis and risk stratification of acute heart failure. J Intern Med 2012; 271: 598––3607. doi: 10.1111/j.1365-2796.2011.02469.x.

4. Wang TJ. Significance of circulating troponins in heart failure: if these walls could talk. Circulation 2007; 116: 1217–1220.

5. Zannad F, Mebazaa A, Juillière Y et al. EFICA Investigators. Clinical profile, contemporary management and one-year mortality in patients with severe acute heart failure syndromes: The EFICA study. Eur J Heart Fail 2006; 8: 697–705.

6. Mueller C, Scholer A, Laule-Kilian K et al. BASEL investigators. Use of B-type natriuretic peptide in the evaluation and management of acute dyspnea. N Engl J Med 2004; 350: 647–654.

7. You JJ, Austin PC, Alter DA et al. EFFECT investigators. Relation between cardiac troponin I and mortality in acute decompensated heart failure. Am Heart J 2007; 153: 462–470.

8. Polturi S, Ventura HO, Mulumudi M et al. Cardiac troponin levels in heart failure. Cardiol Rev 2004; 12: 21–25.

9. La Vecchia L, Mezzena G, Ometto R et al. Detectableserum troponin I in patients with heart failure nonmyocardial ischemic origin. Am J Cardiol 1997; 80: 88–90.

10. Latini R, Masson S, Anand IS et al. ValHeft investigators. Prognostic value of very low plasma concentrations of troponin T in patients with stable chronic heart failure. Circulation 2007; 116: 1242–1249.

11. Ilva T, Lassus J, Siirilä-Waris K et al. Clinical significance of cardiac troponins I and T in acute heart failure. Eur J Heart Fail 2008; 10: 772–779.

12. Horwich TB, Patel J, MacLellan WR et al. Cardiac troponin I is associated with impaired hemodynamics, progressive left ventricular dysfunction, and increased mortality rates in advanced heart failure. Circulation 2003; 108: 833–838.

13. Fonarow G, Peacock WF, Horwich TB et al. ADHERE Scientific Advisory Committee and Investigators. Usefulness of B-type natriuretic peptide and cardiac troponin levels to predict in-hospital mortality from ADHERE. Am J Cardiol 2008; 101: 231–237.

14. De Lemos JA, Morrow DA et al. Brain natriuretic peptide measurement in acute coronary syndromes: ready for clinical application? Circulation 2002; 106: 2868–2870.

15. Galvani M, Ferrini D, Ottani F et al. Natriuretic peptides for risk stratification of patients with acute coronary syndromes. Eur J Heart Fail 2004; 6: 327–333.

16. Braunwald E. Acute coronary syndromes: BNP measurement predicts AMI risk in the elderly. Nat Rev Cardiol 2009; 118: 503–504.

17. Miller WL, Hartman KA, Burritt MF et al. Profiles of serial changes in cardiac troponin T concentrations and outcome in ambulatory patients with chronic heart failure. J Am Coll Cardiol 2009; 54: 1715–1721.