Abstract 9374: High Sensitivity Cardiac Troponin T in Patients with Chronic Heart Failure: Prognostic Value of Changes Over Time and Effects of Randomized Therapy
Aims: We examined the prognostic value of repeated measurements of cardiac troponin T, assayed with a high sensitivity method, in patients with chronic heart failure (HF), and the effect of randomized therapy on the biomarker.
Methods: High sensitivity troponin T (hs-cTnT, Roche Diagnostics GmbH) was assayed at baseline and after 3 months in 1231 patients with chronic HF of any etiology and age enrolled in the multicenter GISSI-HF trial and randomized to n-3 PUFA (1 g/d) or rosuvastatin (10 mg/d) vs. placebo. The association between troponin and mortality (330 events) or mortality and admission to hospital for CV reasons (788 events) was evaluated with Cox multivariable models adjusting for clinical risk factors.
Results: Median baseline hs-cTnT (17 [10–28] ng/L) was close to the upper limit of a reference population (13.5 ng/L). Unexpectedly, patients with concentrations of hs-cTnT within the normal range had a significantly elevated risk compared to those in the 1st decile (Figure). After adjustment for clinical variables, baseline hs-cTnT remained significantly associated with both mortality (HR [95%CI] = 1.15 [1.09–1.22] for 1 SD increment, p<0.0001) and mortality and admission to hospital for CV reasons (1.10 [1.05–1.16], p<0.0001). Relative changes of hs-cTnT over 3-months were also associated to outcome (p for trend across tertiles= 0.001). Randomized treatments (n-3 PUFA or rosuvastatin) did not significantly change hs-cTnT concentrations over 3 months.
Conclusions: Despite very low circulating levels, cardiac troponin and its changes over time are strong predictors of outcome in chronic HF. Randomized treatments had no major impact on troponin levels.
- © 2010 by American Heart Association, Inc.