Abstract 2376: Myocardial Degradation as Indicated by Elevated Troponin T in Nonischemic Congestive Heart Failure is Predictive of Adverse Events, Including Conversion from Predominantly Diastolic to Systolic Left Ventricular Dysfunction
Objective: To assess the predictive role of myocardial degradation as indicated by troponin T (tnT) elevation in congestive heart failure (CHF) of systolic and diastolic nature, in the absence of significant coronary artery disease.
Methods: We studied records of CHF patients that visited the Cleveland Clinic emergency department, had at least one tnT value measured and subsequently demonstrated less than 30% stenoses on coronary angiography.
Results: Seventy-eight consecutive patients were included. Ejection fraction (EF) was assessed in 75 patients, of which 30 had an EF > 40%. Follow-up echocardiogram was performed in 55 patients, of which 22 with an initial EF > 40%. Two years follow-up cumulative adverse events (death, institution of mechanical ventilation, necessity of inotropes or vasopressors and ejection fraction deterioration of 10% or more) were predicted by tnT ≥ 0.01 ng/ml in both subgroups of patients with EF > 40% (P=0.02), and EF ≤ 40% (P=0.05). Of 13 patients with initial EF > 40% and tnT ≥ 0.01 ng/ml, five (of which three had an EF ≥ 50%) demonstrated EF deterioration to 40% and less, while none of the nine patients with EF > 40% and tnT < 0.01 ng/ml experienced this phenomenon (P=0.05). Three of the five patients that converted to EF ≤ 40% presented with left bundle branch block (LBBB), while none of the 17 patients in whom EF remained > 40% had LBBB (P=0.006). The sensitivity and specificity of tnT ≥ 0.01 ng/ml and LBBB to predict conversion from predominantly diastolic (EF > 40%) to systolic left ventricular dysfunction (EF ≤ 40%) were 100% and 53% for tnT, and 60% and 100% for LBBB respectively.
Conclusion: In CHF patients with no significant coronary artery disease elevated tnT was predictive of adverse events in subgroups of patients with predominantly diastolic or systolic left ventricular dysfunction. In patients with predominantly diastolic CHF, tnT ≥ 0.01 ng/ml and LBBB predicted conversion to systolic left ventricular dysfunction. In our small group of patients the sensitivity of these two variables for predicting conversion to systolic dysfunction was higher for tnT, while specificity was better for LBBB. These findings could suggest possible preventive strategies in patients with CHF of predominantly diastolic dysfunction.