Prognostic value of high-sensitivity cardiac troponin I in heart failure patients with mid-range and reduced ejection fraction

Authors	LOKAJ Petr ŠPINAR Jindřich ŠPINAROVÁ Lenka MALEK Filip LUDKA Ondřej KREJČÍ Jan OSTADAL Petr VONDRAKOVA Dagmar LÁBR Karel ŠPINAROVÁ Monika PÁVKOVÁ GOLDBERGOVÁ Monika MIKLÍKOVÁ Marie HELÁNOVÁ Kateřina PARENICOVA Ilona JAKUBO Vladimír BENEŠOVÁ Klára MIKLIK Roman JARKOVSKÝ Jiří ONDRÚŠ Tomáš PAŘENICA Jiří
Year of publication	2021
Type	Article in Periodical
Magazine / Source	Plos one
MU Faculty or unit	Faculty of Medicine
Citation
Web	https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0255271
Doi	http://dx.doi.org/10.1371/journal.pone.0255271
Keywords	high-sensitivity cardiac troponin I; heart failure patients; ejection fraction
Description	Background The identification of high-risk heart failure (HF) patients makes it possible to intensify their treatment. Our aim was to determine the prognostic value of a newly developed, high-sensitivity troponin I assay (Atellica(R), Siemens Healthcare Diagnostics) for patients with HF with reduced ejection fraction (HFrEF; LVEF < 40%) and HF with mid-range EF (HFmrEF) (LVEF 40%-49%). Methods and results A total of 520 patients with HFrEF and HFmrEF were enrolled in this study. Two-year all-cause mortality, heart transplantation, and/or left ventricular assist device implantation were defined as the primary endpoints (EP). A logistic regression analysis was used for the identification of predictors and development of multivariable models. The EP occurred in 14% of the patients, and these patients had higher NT-proBNP (1,950 vs. 518 ng/l; p < 0.001) and hs-cTnI (34 vs. 17 ng/l, p < 0.001) levels. C-statistics demonstrated that the optimal cut-off value for the hs-cTnI level was 17 ng/l (AUC 0.658, p < 0.001). Described by the AUC, the discriminatory power of the multivariable model (NYHA > II, NT-proBNP, hs-cTnI and urea) was 0.823 (p < 0.001). Including heart failure hospitalization as the component of the combined secondary endpoint leads to a diminished predictive power of increased hs-cTnI. Conclusion hs-cTnI levels >= 17 ng/l represent an independent increased risk of an adverse prognosis for patients with HFrEF and HFmrEF. Determining a patient's hs-cTnI level adds prognostic value to NT-proBNP and clinical parameters.