Persistent increase in cardiac troponin T at hospital discharge predicts repeat hospitalization in patients with acute decompensated heart failure

Abstract

Background: High-sensitive cardiac troponin T (hsTnT) is a sensitive biomarker of myocardial damage and predictor of acute decompensated heart failure (ADHF). However, there is little information on changes over time in hsTnT level during ADHF management. The aim of this prospective study was to evaluate changes in hsTnT levels between admission and at discharge in patients with ADHF, and identify factors that determine such levels and their prognostic significance.

Methods and results: We evaluated 404 ADHF patients with abnormal hsTnT levels (≥0.0135 ng/ml) on admission. The median (interquartile ranges) hsTnT levels on admission, at discharge, and percent changes in hsTnT levels were 0.038 (0.026 to 0.065), 0.032 (0.021 to 0.049) ng/ml, and -12.0 (-39.8 to 7.4) % respectively. The numbers of patients with falling (hsTnT decrease > -15%), stable (hsTnT change between -15 and +15%) and rising (hsTnT increase > +15%) hsTnT level at discharge were 190, 146, and 68, respectively. The percent change in B-type natriuretic peptide (BNP) levels was greater in the falling group, compared to the stable (p<0.001) and rising groups (p<0.001). Changes in hsTnT levels correlated significantly with changes in BNP levels (ρ = 0.22, p<0.001). Multivariate Cox regression analysis identified rising or stable hsTnT at discharge as a significant predictor of heart failure-related rehospitalization (hazard ratio: 1.69; 95% confidence interval: 1.06 to 2.70; p = 0.03).

Conclusions: Persistent increase in hsTnT levels at discharge correlated with inadequate decrease of BNP levels, and was a predictor of poor clinical outcome, with repeat heart failure hospitalizations.

Fig 1. Distribution of hsTnT level on admission to the hospital (A), at discharge (B), changes in hsTnT levels (net) (C) and changes in hsTnT levels (percent) (D).

The median (interquartile ranges) high sensitive cardiac troponin T (hsTnT) levels on admission, at discharge, and changes in hsTnT levels (net) were 0.038 (0.026 to 0.065), 0.032 (0.021 to 0.049), and -0.004 (-0.017 to 0.002) ng/ml, respectively. The percent change of hsTnT was -12.0 (-39.8 to 7.4) %.

Fig 2. Comparison of Kaplan—Meier estimates for probability of (A) free of all cause death, (B) free of cardiovascular death, and (C) free of heart failure-related rehospitalization among the falling, stable, and rising groups.

All cause death and cardiovascular death were not different among the falling, stable, and rising groups (Fig 2A, B). HF-related rehospitalization was significantly lower in falling group (p = 0.047; log-rank test; Fig 2C).