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High sensitive troponin is associated with high risk clinical profile and outcome in acute heart failure.
Cardiol J. 2015 Sep 28;
Authors: Diez M, Talavera ML, Conde DG, Campos R, Acosta A, Trivi MS
Abstract
BACKGROUND: The aim of the study was to evaluate the value of high sensitivity cardiac troponin (hs-cTn) for identifying high-risk patients.
METHODS AND RESULTS: 187 patients admitted with acute heart failure (without myocardialinfarction) were consecutively included; hs-cTn was measured at admission; therelation between elevated hs-cTn and the clinical outcome during hospitalization and at90 days was analyzed;93% (n=174) had hs-cTn above the maximal normal value (14ng/L); median hs-cTnwas 42ng/L (IQR 24-81). Patients with ejection fraction (EF) ≤45% had higher hs-cTnvalues (p=0.0004). Patients with low cardiac output syndrome (LCOS) or shock had higher troponin levels compared with those with less severe clinical presentations (p=0.004). Patients who required inotropic presented higher troponin values (p=0.002),troponin values were also higher in those requiring complex therapies (intra-aorticballoon pump, mechanical ventilation or hemodialysis, p=0.002). At 90-day follow-up,28 patients died (15,5%) and 27 rehospitalizations occurred (55 events). The risk ofevents was greater in patients with hs-cTn>42ng/L (0.021), low blood pressure atadmission (p=0.002), LCOS or shock (p<0.0001), EF≤45% (p=0.005) and inotropic use(p<0.0001). In multivariate analysis, only inotropic agents requirements was associated independently with high risk of death or rehospitalizations at 90 days (p=0.007).
CONCLUSIONS: Elevation of hs-cTn is a finding almost constant in patients withde compensated heart failure. In subjects with higher troponin levels ventricular dysfunction is frequent. The use of hs-cTn for risk stratification at admission helps toidentify populations with poor outcome during hospitalization and higher risk of death or rehospitalizations during follow-up who will require rapid implementation of an aggressive treatment.
PMID: 26412605 [PubMed - as supplied by publisher]