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Circulation. 2018 Jan 16;137(3):286-297. doi: 10.1161/CIRCULATIONAHA.117.031560.

Prognostic Value of High-Sensitivity Troponin T in Chronic Heart Failure: An Individual Patient Data Meta-Analysis.

Author information

1
Scuola Superiore Sant'Anna, Pisa, Italy (A.A., G.V., C.P., M.E.).
2
Massachusetts General Hospital and Harvard Clinical Research Institute, Boston (J.L.J., H.K.G.).
3
Fondazione Toscana G. Monasterio, Pisa, Italy (G.V., A.R., C.P., M.E.).
4
Department of Cardiovascular Research IRCCS - Istituto di Ricerche Farmacologiche - "Mario Negri," Milano, Italy (R.L., S.M., M.M., G.T.).
5
Division of Cardiovascular Medicine, University of Minnesota, Minneapolis (I.S.A., J.N.C.).
6
Department of Cardiology, VA Medical Centre, Minneapolis, MN (I.S.A.).
7
GVM Hospitals of Care and Research, E.S. Health Science Foundation, Cotignola, Italy (L.T.).
8
Research Institute of Internal Medicine, Oslo University Hospital, Rikshospitalet, Norway (T.U., S.H.N.).
9
Faculty of Medicine, University of Oslo, Norway (T.U.).
10
K. G. Jebsen Thrombosis Research and Expertise Centre, University of Tromsø, Norway (T.U.).
11
Department of Cardiology, Maastricht University Medical Centre, The Netherlands (H.-P.G.-L.R.).
12
Hospital Universitari Germans Trias i Pujol, Badalona (Barcelona), Spain (A.B.G., J.L.).
13
University Medical Centre Groningen, The Netherlands (R.A.d.B.).
14
Department of Cardiovascular Medicine, Fukushima Medical University, Japan (A.Y., Y.T.).
15
Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Denmark (M.E., I.G.).
16
Department of Medical Sciences, Cardiology, Uppsala University, Sweden (K.M.E.).
17
Faculty of Internal Medicine, Wilhelminenspital and Sigmund Freud University, Medical School, Vienna, Austria (K.H., I.T.).
18
Heart and Vascular Institute, Cleveland Clinic, OH (W.H.W.T.).
19
Department of Cardiology, Oslo University Hospital, Ullevål, Norway (J.G.).
20
Centre for Heart Failure Research, University of Oslo, Norway (J.G.).
21
Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (J.G.).
22
Scuola Superiore Sant'Anna, Pisa, Italy (A.A., G.V., C.P., M.E.) emdin@ftgm.it m.emdin@santannapisa.it.

Abstract

BACKGROUND:

Most patients with chronic heart failure have detectable troponin concentrations when evaluated by high-sensitivity assays. The prognostic relevance of this finding has not been clearly established so far. We aimed to assess high-sensitivity troponin assay for risk stratification in chronic heart failure through a meta-analysis approach.

METHODS:

Medline, EMBASE, Cochrane Library, and Scopus were searched in April 2017 by 2 independent authors. The terms were "troponin" AND "heart failure" OR "cardiac failure" OR "cardiac dysfunction" OR "cardiac insufficiency" OR "left ventricular dysfunction." Inclusion criteria were English language, clinical stability, use of a high-sensitivity troponin assay, follow-up studies, and availability of individual patient data after request to authors. Data retrieved from articles and provided by authors were used in agreement with the PRISMA statement. The end points were all-cause death, cardiovascular death, and hospitalization for cardiovascular cause.

RESULTS:

Ten studies were included, reporting data on 11 cohorts and 9289 patients (age 66±12 years, 77% men, 60% ischemic heart failure, 85% with left ventricular ejection fraction <40%). High-sensitivity troponin T data were available for all patients, whereas only 209 patients also had high-sensitivity troponin I assayed. When added to a prognostic model including established risk markers (sex, age, ischemic versus nonischemic etiology, left ventricular ejection fraction, estimated glomerular filtration rate, and N-terminal fraction of pro-B-type natriuretic peptide), high-sensitivity troponin T remained independently associated with all-cause mortality (hazard ratio, 1.48; 95% confidence interval, 1.41-1.55), cardiovascular mortality (hazard ratio, 1.40; 95% confidence interval, 1.33-1.48), and cardiovascular hospitalization (hazard ratio, 1.42; 95% confidence interval, 1.36-1.49), over a median 2.4-year follow-up (all P<0.001). High-sensitivity troponin T significantly improved risk prediction when added to a prognostic model including the variables above. It also displayed an independent prognostic value for all outcomes in almost all population subgroups. The area under the curve-derived 18 ng/L cutoff yielded independent prognostic value for the 3 end points in both men and women, patients with either ischemic or nonischemic etiology, and across categories of renal dysfunction.

CONCLUSIONS:

In chronic heart failure, high-sensitivity troponin T is a strong and independent predictor of all-cause and cardiovascular mortality, and of hospitalization for cardiovascular causes, as well. This biomarker then represents an additional tool for prognostic stratification.

KEYWORDS:

heart failure; meta-analysis; prognosis; troponin T; ventricular dysfunction, left

[Indexed for MEDLINE]

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