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Worse outcomes related to elevated troponin levels in patients with decompensated HFpEF
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Elevated troponin levels were found to be related to poorer in-hospital and postdischarge outcomes in patients with decompensated HF with preserved ejection fraction. This association was observed independent of other predictive variables.
“Future studies are needed to determine if measurement of troponin levels among patients with decompensated HFpEF may be useful for risk stratification,” Ambarish Pandey, MD, of the division of cardiology, University of Texas Southwestern Medical Center, Dallas, and colleagues wrote.
Pandey and colleagues conducted an observational analysis of 34,233 patients (median age, 79 years; 33.4% men) from the American Heart Association’s Get With the Guidelines–Heart Failure registry. All patients presented with decompensated HFpEF (EF 50%) and were admitted to the hospital from 2009 to 2014. All patients had quantitative or categorical measures of troponin levels recorded and available.
Troponin elevation
Overall, 26,896 patients (78.6%) had troponin I measurements and 7,319 (21.4%) had troponin T measurements. An elevation in troponin levels was found in 7,732 (22.6%) of these patients. Higher serum creatinine level, black race, older age and ischemic heart disease were shown to be linked to troponin elevation in an adjusted analysis.
A higher chance of in-hospital mortality was found with elevated troponin (OR = 2.19; 95% CI, 1.88-2.56). Elevated troponin was also found to be related to greater length of hospital stay (length of stay > 4 days, OR = 1.38; 95% CI, 1.29-1.47), and lower likelihood of discharge to home (OR = 0.65; 95% CI, 0.61-0.71), regardless of other predictive variables or confounders.
An increased risk for 30-day mortality was also found with elevated troponin I levels (HR = 1.59; 95% CI, 1.42-1.8), as well as an increase in 30-day all-cause readmission (HR = 1.12; 95% CI, 1.01-1.25) and 1-year mortality (HR = 1.35; 95% CI, 1.26-1.45).
Early assessment
“Troponin elevation is common among hospitalized patients with decompensated HFpEF and is associated with poor in-hospital and long-term clinical outcomes. Taken together, these findings suggest a role of early troponin assessment as an important risk-stratification tool during the initial evaluation of these patients,” Pandey and colleagues wrote.
In a recently published related editorial, Gabriel Sayer, MD, and Nir Uriel, MD, MSc, both from the University of Chicago, wrote: “These findings raise the question of whether troponin level is simply a marker of disease severity or whether troponin release is a phenotypic characteristic of a specific subset of patients with HFpEF. Future research should investigate the presence of troponin release among previously identified HFpEF subgroups.
“What is clear from this study is that the presence of an elevated troponin level identifies a subgroup of patients requiring intensive in-hospital evaluation and treatment followed by more rigorous follow-up after discharge,” Sayer and Uriel wrote. – by Suzanne Reist
Disclosure: Pandey reports no relevant financial disclosures. Please see the full study for a list of the other researchers’ relevant financial disclosures. Sayer and Uriel report no relevant financial disclosures.
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