• Heart Failure

Patients with chronic heart failure (CHF) and dilated cardiomyopathy (DCM) who have low cardiac troponin T (TnT) levels have significantly fewer cardiovascular (CV) events than those with high TnT [Sato Y et al. Heart 1997; Sato Y et al. Circulation 2001]. CHF patients with high troponin and high brain natriuretic peptide (BNP) levels have the highest event rates [Taniguchi R et al. Circ J 2004; Tanaguchi R et al. Heart Vessels 2006]. Yukihito Sato, MD, Amagasaki Hospital, Hyogo, Japan, discussed the association between TnT and prognosis in patients with HF.

High-sensitivity TnT (hs-TnT) assays accurately measure very low TnT concentrations. The Val-HeFT study found an association between high levels of hs-TnT and HF mortality and hospitalizations [Latini R et al. Circulation 2007].

In patients with acute decompensated HF, those with the highest baseline TnT or troponin I (TnI) had the highest risk of in-hospital mortality [Peacock WF 4^th et al. N Engl J Med 2008]. Dr. Sato showed that elevated baseline hs-TnI in patients with acute HF was associated with a higher rate of cardiac events (p<0.05) [Kuwabara Y et al. Circ J 2007]. In another study, acute HF patients with elevated serial hs-TnI had the highest rate of cardiac events versus those with low serial hs-TnI [Xue Y et al. Eur J Heart Fail 2011].

Hs-TnT has been detected in 80% of patients with essential hypertension [Sato Y et al. J Cardiol 2011] and in 66% of community-dwelling older adults [deFilippi CR et al. JAMA 2010]. The baseline concentration of hs-TnT and a >50% increase in hs-TnT at follow-up in the community-dwelling population were predictors of adverse CV events.

Concentrations of hs-TnT increase with the severity of heart disease, from hypertension to CHF to acute HF (Figure 1). Dr. Sato concluded that baseline TnT concentration and elevated serial TnT concentrations at follow-up are prognostic markers in patients with HF. Combined measurements of TnT and BNP can identify patients at highest risk of adverse cardiac events. Patients with the highest hs-TnT concentrations have the highest risk of adverse cardiac events.

• Download figure
• Open in new tab
• Download powerpoint

Figure 1.

Concentrations of hs-TnT in Hypertension, CHF, and Acute HF.

CHF=chronic heart failure; HF=heart failure; hs-TnT=high-sensitivity troponin T.Reproduced with permission from Y. Sato, MD.

• © 2012 MD Conference Express®