Abstract 18067: Serum Troponin In Patients Presenting With Acute Heart Failure and High BNP/NT-proBNP Without Electrocardiographic Evidence of ST-Elevation Myocardial Infarction
Introduction: Serum troponins could increase in acute heart failure (AHF) but its clinical significance and correlation with BNP are not well explored.
Hypothesis: We investigated the implication of elevated troponin in AHF with high BNP/NT-proBNP without ST-elevation nmyocardial infarction (STEMI).
Methods: Data from 5005 AHF patients admitted over 10 months in 7 Gulf countries were analyzed with a 1-year follow-up . After exclusion of STEMI, AHF patients with high BNP (BNP>400pg/ml or NT-proBNP >450pg/ml) were categorized according to their serum troponin status (group1; negative and group2; positive).
Results: There were 1042 patients with high BNP, of them 512 had positive troponin (49%) with a mean age of 64±13. In comparison to group 1, patients with positive troponin were significantly older, more males and more likely to have diabetes mellitus (DM),hypertension, obesity and dyslipidemia (p=0.001 for all). Group 1 presented mainly with palpitation, easy fatigue, and NYHA class 3 whereas group 2 patients were more likely to present with chest pain, and NYHA class 4 (p=0.001).Mean hemoglobin A1c, eGFR and BNP/NT-proBNP were greater in group2(p=0.001).Atrial fibrillation was more common in group1 (p=0.001). Left ventricle ejection fraction (LVEF%),cardiac arrest, obstructed coronary vessels,use of inotropes or IABP, and 3-month readmission were comparable in the 2 groups. Hospital use of beta blockers (BB) and ACEI/ARBs were more frequent in group1 (p=0.001). Hospital,3-month and 1-year mortality were greater in group2 (p=0.001).After adjustment for age, sex, DM, hypertension, renal impairment, multivariate logistic regression analysis showed that reduced LVEF and lack of hospital BB and ACEI/ARBs use were the independent predictors of short-and long-term mortality regardless of the troponin status.
Conclusions: In the absence of STEMI among patients presenting with AHF, positive troponin has significant impacts on short-and long-term mortality. However, this effect on mortality could be counteracted by the use of evidence based medications and preserved LV function. Moreover,high BNP/NT-proBNP is correlated with elevated troponin. Our findings are important for better understanding, risk stratification and management of AHF
Author Disclosures: A. El-Menyar: None. K. Sulaiman: None. W. AlMahmeed: None. R. Singh: None. N. Asaad: None. J. Al Suwaidi: None.
- © 2016 by American Heart Association, Inc.