Abstract 11229: Incremental Prognostic Information Of High Sensitivity Troponin I Plasma Levels Over Left Ventricular Filling Pattern At Doppler Echocardiography In Patients With Chronic Systolic Heart Failure
Purpose: accumulating data provide support for the prognostic relevance of high-sensitivity troponin I (hsTNI) plasma levels in patients with chronic heart failure (HF). It is not clear, however, whether hsTNI might provide incremental prognostic information over echocardiography in such patients.
Methods: A cohort of 197 consecutive NYHA class II or III patients with ambulatory chronic HF due to primary dilated cardiomyopathy or ischemic heart disease and left ventricular (LV) ejection fraction <35% was prospectively studied (mean age 53±13 years, 35 women (18%) and 65 (33%) with ischemic etiology). Standard echocardiographic examination including LV end-diastolic volume, LV ejection fraction, mitral regurgitation, deceleration time of E wave mitral flow, systolic pulmonary artery pressure, TAPSE and determinations of plasma levels of natriuretic peptides (BNP) and hsTNI were performed on the same day. Median follow-up was 26 months (25-75 percentiles: 16-37 months). The primary end-point of survival analysis was the combined end-point of death, urgent cardiac transplantation or HF hospitalisation.
Results: Sixty events were recorded during the follow-up period: 12 patients died, 4 underwent UNOS 1 cardiac transplantation and 44 were hospitalised for acute HF. At the multivariable analysis including clinical and echocardiographic parameters and plasma biomarkers, only a restrictive LV filling pattern at Doppler echocardiography (RFP) and hsTNI plasma levels ≥0.04 ng/ml were independent prognostic indicators (HR 3.2, 95% CI 1.9-6.0 p < 0.0001 and HR 2.7, 95% CI 1.5-4.8 p = 0.0002 respectively). Importantly, hsTNI levels ≥0.04 ng/ml were associated with a significant poorer prognosis both in patients with RFP (p=0.0003) and in patients with non restrictive filling pattern (NRFP) (p=0.0065).
Conclusions: elevated hsTNI levels yield incremental prognostic information over LV filling pattern at Doppler echocardiography in ambulatory patients with chronic systolic HF.
- © 2011 by American Heart Association, Inc.