Abstract 3610: Troponin and BNP: Heart Failure’s Deadly Duo
Introduction: While troponin (Tn) is frequently elevated in acutely decompensated heart failure (ADHF), its prognostic implications are poorly characterized. Our purpose was to evaluate the association between acute mortality and the combination of BNP and Tn in ADHF.
Methods: Using the ADHERE registry, we performed an analysis comparing in-hospital mortality to dichotomously stratified Tn results, defined as elevated or not, versus continuous BNP concentrations. An abnormal Tn was defined as either ’positive’, a TnI > 0.1 ng/mL, or TnT > 0.01 ng/mL. Analysis used ANOVA, or Wilcoxon, and Chi Square.
Results: Of 63,570 patients, 3287 (5.1%) had an elevated Tn. Patients with elevated Tn more often had a history of CAD (63.4, vs 58.7%), congestion on chest x-ray (79.4, vs 75.4%), and rales (73.5, vs 69%), all p <0.0001. Median creatinine was 1.5 (IQR 1.1, 2.2), and 1.3 mg/dL (IQR 1.0, 1.8), and median BNP was 1350 (IQR 709, 2690) and 828 pg/mL (IQR 429, 1670), for those with, and without, an elevated Tn, respectively (all p <0.0001). A multivariate model with Tn and BNP, adjusted for age, sodium, BUN, creatinine, systolic and diastolic BP, pulse, and dyspnea at rest, found the index visit odds ratio for mortality with an elevated troponin was 1.864 (95% CI 1.623, 2.141), p<.0001, and for a 400-unit change in BNP was 1.096 (95% CI 1.083, 1.110), p<.0001. The figure⇓ represents the relationship between Tn, BNP, and acute mortality using locally weighted scatterplot smoother.
Conclusions: An elevation of troponin is associated with a marked acute mortality increase in ADHF and mortality is further amplified in direct proportion to the amount of BNP elevation.