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Troponin Levels and Prognosis in Patients with Acute Heart Failure

In an observational study, elevations in cardiac troponin predicted poor outcome — but does routine testing substantially affect treatment decisions?

The prognostic importance of serum cardiac troponin levels in patients admitted to the hospital with heart failure is not well defined. Using data from an industry-sponsored registry, investigators sought to describe the association of elevated troponin levels with the risk for in-hospital death in patients hospitalized with acute decompensated heart failure. They excluded patients with a creatinine level >2.0 mg/dL because renal dysfunction may influence troponin concentration.

Of the 105,388 heart failure hospitalizations in the registry, 84,872 included a troponin measurement at initial evaluation, and 67,924 met the study enrollment criteria. The 4240 hospitalizations in which troponin levels were elevated were more likely to culminate in death than the 63,684 hospitalizations in which no elevation was found (8.0% vs. 2.7%, P<0.001). Higher troponin levels were associated with a higher mortality risk. The adjusted odds of in-hospital death with an elevated troponin level were 2.55 (95% confidence interval, 2.24–2.89).

Ischemic heart failure, which was reported in about 50% of both elevated-troponin and non–elevated-troponin patients, was not associated with troponin status or mortality risk.

Comment: This large registry study reveals that elevated troponin levels occur infrequently — it is hard to estimate exactly how often from this article because troponin was not measured in about 20% of registry participants — but convey prognostic information. Whether cardiac troponin testing adds meaningfully to clinical assessment and should alter clinical care of patients with acute heart failure is not clear. This measurement appears to have been adopted into current practice in advance of evidence about how we should use it.

— Harlan M. Krumholz, MD, SM

Published in Journal Watch Cardiology May 14, 2008

Citation(s):

Peacock WF IV et al. Cardiac troponin and outcome in acute heart failure. N Engl J Med 2008 May 15; 358:2117.

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