[Single cardiac troponin T measurement predicts risk for adverse outcome in decompensated heart failure].

BACKGROUND

The slight increase in cardiac troponin in the blood of patients with heart failure (HF) suggests that myofibrils are degraded in the myocardium and released in the circulation, reflecting a continuous and progressive injury process in the contractile system.

OBJECTIVE

To correlate the serum levels of cardiac troponin T (TnT) at the hospital admission of patients with decompensated HF and prognosis.

METHODS

A total of 79 consecutive patients, hospitalized due to decompensated HF, with LVEF < 45%, were included in the study. Patients were followed for 8 months. We excluded patients using intravenous inotropic agents, as well as those with acute coronary syndrome, pulmonary thromboembolism, creatinine levels > 2.5 mg%, liver failure, or neuromuscular diseases.

RESULTS

High levels of TnTc (>0.02 ng/ml) were detected in 37 patients (46.84%). The global mortality was 35.4%. In the groups with high TnT and low TnT levels (<0.02 ng/ml) there were, respectively, 19 versus 9 deaths (RR=2.4; 95%CI 1.24-4.63; p=0.011), 5 versus 4 heart transplants (RR=1,42; 95%CI 0.41-4.89; p=0.73), 11 versus 7 patients needed IV inotropic agents (RR=1.78; 95%CI 0.77-4.12; p=0.26) and 14 versus 10 patients were re-hospitalized (RR=1.85; 95%CI 0.95-3.6; p=0.10). Mean troponin levels were significantly higher in those individuals who died (0.071+/-0,119 vs 0.032+/-0.046; p=0.004). At the multivariate analysis, the persistence of the third sound and the need for IV inotropic agents showed to be independent predictors of death; however, we observed a higher tendency towards mortality for patients presenting high TnT when compared to those with low troponin levels (HR=2.64; 95%CI 0.91-7.63; p=0.07).

CONCLUSION

The single troponin measurement at hospital admission in patients with decompensated HF predicts adverse outcomes and should be considered at the early stratification of long-term morbimortality.