Troponin as a prognostic risk factor in patients hospitalized for decompensation of chronic systolic heart failure

Czech version

Authors: R. Štípal jr.; O. Ludka; V. Musil; Z. Pozdíšek; J. Jarkovský; J. Špinar
Published in: Kardiol Rev Int Med 2012, 14(3): 182-189
Category:

Overview

Background:
The significance of evaluation of cardiac troponins is associated mainly with diagnostics of acute coronary syndromes. An increasing number of evidences of the significance of evaluation of cardiac enzymes as markers of myocardial damage even in acute heart failure have been observed lately. Elevation of cardiac troponins suggests presence of damage or death of myocytes, which is considered to be the main mechanism of development of myocardial dysfunction and acute decompensated heart failure. The current guidelines for diagnostics and treatment of acute heart failure do not mention routine examination of troponin. However, recently published data point out the significance of examination of cardiac troponins as a useful prognostic indicator for risk stratification of patients, both in patients with ischaemic and in patients with non-ischaemic aethiology of their heart failure.

Objective:
To determine the incidence of troponin-T positivity in patients hospitalized for acute decompensated chronic systolic heart failure without evidence of acute coronary syndrome according to guidelines of the Czech Society of Cardiology, and also to find out whether the troponin-T positivity, apart from the effect on short-term mortality, is also related to long--term prognosis in these patients.

Methods:
Prospective, single-centre study focused on non-invasive prognostic markers in acute heart failure; troponin-T being determined on admission with control examination after 12 hours. Cohort: 55 patients, 71% male, 29% female, aged 68 years, body mass index 27.4 kg/m², aetiology of chronic heart failure – 73% ischaemic heart disease, 15 % dilated cardiomyopathy, 12 % other, NYHA classification in long-term history I/II/III – 32.7/56.4/10.9%, on admission – swelling of lower limbs 49.1%, rales 87.3%, orthopnoea 58.2%, BNP on admission 1,090 pg/ml, on discharge 429 pg/ml, LVEF 27.0%, length of hospitalization 10 days.

Results:
troponin-T positive – 45 (81.8%) patients, troponin-T negative – 10 (18.2%) patients. Maximum troponin-T value is a positive risk factor for the overall (p = 0.032) and cardiovascular (p = 0.029) mortality. Cut-off value for patient’s risk of death is 0.03 µg/l (follow-up of 17 months).

Conclusion:
In most of the patients hospitalized for acute decompensated chronic systolic heart failure we have proved increase in troponin-T; troponin positivity is a valuable marker for estimation of prognosis in patients with chronic systolic heart failure and their risk stratification.

Keywords:
heart failure – prognosis – troponin – natriuretic peptides

Supported by grant Ministry of Health Czech Republic 10422-3/2009.

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