Published online before print October 11, 2004, doi: 10.1161/01.CIR.0000145158.33801.F3
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(Circulation. 2004;110:2376-2382.)
© 2004 American Heart Association, Inc.
Heart Failure |
Ongoing Myocardial Injury in Stable Severe Heart Failure
Value of Cardiac Troponin T Monitoring for High-Risk Patient Identification
From the Heart Failure Clinic, Instituto de Cardiología Juana F. Cabral, Corrientes (E.R.P., S.M.M., J.P.C.C., N.A., J.L.R.S., J.R.C., A.E.P., E.H.G., R.O., M.B.), and the Instituto de la Familia, San Isidro, Argentina, Buenos Aires (A.B.), Argentina.
Correspondence to Eduardo Roque Perna MD, Heart Failure Clinic, Instituto de Cardiología Juana F. Cabral, Bolívar 1334, Corrientes, 3400, Argentina. E-mail pernaucic{at}hotmail.com or ucic@funcacorr.org.ar
Received March 21, 2004; de novo received April 20, 2004; revision received June 4, 2004; accepted June 7, 2004.
Background— The progression of chronic heart failure (CHF) is related to ongoing myocyte loss, which can be detected by cardiac troponin T (cTnT). We examined the prevalence and prognostic value of increased cTnT concentrations in serial blood specimens from patients with severe CHF.
Methods and Results— Clinical, echocardiographic, and 6-minute walk test data were collected prospectively at baseline and at 1 year in 115 outpatients (mean age, 61±11 years; 75% men; 62% coronary heart disease) with CHF and a left ventricular ejection fraction <40%. Blood samples were collected at baseline and at 3, 6, and 12 months of follow-up. cTnT concentrations 
0.02 ng/mL were considered abnormal, and a Tn index (highest cTnT measurement/0.02 ng/mL) was calculated. In 62 patients (54%), cTnT was consistently <0.02 ng/mL (group 1); 28 (24%) had a single abnormal cTnT result (group 2); and 25 (22%) had 2 abnormal cTnT results (group 3). At 18 months, CHF hospitalization-free survival was 63%, 46%, and 17%, respectively (P=0.0001). In a Cox proportional-hazards model, hospitalization for worsening CHF in the previous year (HR=2.1; 95% CI, 1.1 to 4.1), functional class III–IV (HR=2.3; 95% CI, 1.1 to 4.6), and number of abnormal cTnT samples (HR=1.6; 95% CI, 1.1 to 2.4) were independently associated with prognosis. A cTnT rise of 0.020 ng/mL in any sample was associated with an excess of 9% (95% CI, 1% to 18%) in the incidence of combined end point.
Conclusions— Abnormal cTnT concentrations were detected in >50% of outpatients with advanced CHF. This ongoing myocardial necrosis was a strong predictor of worsening CHF, suggesting a role of cTnT-based monitoring to identify high-risk patients.
Key Words: heart failure • troponin • prognosis
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