Prognostic value of cardiac troponin T in patients with moderate to severe heart failure scheduled for cardiac resynchronization therapy

doi:10.1016/j.ahj.2010.09.021

American Heart Journal

Volume 161, Issue 6, June 2011, Pages 1031-1037

https://doi.org/10.1016/j.ahj.2010.09.021 Get rights and content

Background

Predicting response to cardiac resynchronization therapy (CRT) is challenging. Highly sensitive cardiac troponin T (hsTnT) might predict response to CRT and identify patients at a high risk of experiencing severe cardiovascular events. We investigated whether baseline levels of hsTnT were associated with response to CRT and with severe cardiovascular events after long-term follow-up.

Methods

Eighty-one consecutive patients were included according to the current guidelines for CRT. Biochemical, functional, and clinical parameters were assessed at baseline and at 3, 6, and 12 months of follow-up; and mortality/cardiac transplantation after 46 ± 6 months of follow-up was investigated. Cardiac magnetic resonance imaging and echocardiography were used to assess left ventricular function including viability and remodeling.

Results

Seventy-five patients completed 12 months of follow-up; and after a follow-up of 46 ± 6 months, a total of 15 patients died, 13 of these from cardiovascular causes, and 7 underwent heart transplantation. Baseline hsTnT <15 ng/L predicted response to CRT and was associated with a more favorable outcome with regard to severe cardiovascular events. Multivariate analysis found that presence of transmural scar tissue/fibrosis on magnetic resonance imaging and use of statins were independently associated with higher concentrations of hsTnT at baseline. There was a strong correlation between hsTnT and N-terminal pro–B-type natriuretic peptide levels.

Conclusions

Highly sensitive TnT levels were elevated in the majority of heart failure patients who were scheduled for CRT. The HsTnT levels predicted response to CRT as well as long-time survival.

Section snippets

Patients and study protocol

The study was an open-label, prospective, longitudinal, and observational study and comprised 81 consecutively recruited patients with stable HF referred to our hospital for evaluation for elective CRT. The selection criteria for inclusion were chosen according to the European Society of Cardiology/American Heart Association/American College of Cardiology/European Heart Rhythm Association guidelines for CRT in moderate to severe chronic HF.¹⁰ All patients had a coronary angiogram <3 months

Results

Eighty-one patients were included in the study, 15 (19%) were female, mean age was 64 ± 10 years, and 52% had dilated and 48% had ischemic cardiomyopathy. Mean QRS duration was 175 ± 22 milliseconds. At baseline, echocardiography showed enlarged LV end-diastolic volume (LVEDV) (265 ± 111 mL) and LVESV (210 ± 99 mL) with severely reduced contractions (LVEF 22% ± 8%). In all, 75 patients completed the study period of 12 months. Three patients died (2 because of worsening of HF and 1 because of

Discussion

Our findings demonstrate, first, how elevated hsTnT levels are present in the majority of HF patients scheduled for CRT and, notably, detectable hsTnT levels predicted response to CRT as well as severe cardiovascular events. However, these data must be interpreted with caution. Although our data suggest that hsTnT may predict survival and response to CRT in these patients, larger studies are needed to define a particular cutoff that can be used in clinical practice.

Detectable hsTnT levels in

Conclusion

Our findings suggest that elevated TnT levels have prognostic importance in HF patients, with nonischemic and, in particular, ischemic etiology, who are scheduled for CRT. Reduction in levels of TnT during CRT may be associated with attenuated cardiomyocyte destruction and reverse remodeling of the LV, resulting in a more favorable long-term outcome. Measurement of hsTnT before device implantation may help to identity responders to CRT, and measurement during CRT may help to monitor the effect

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Cardiac resynchronization therapy (CRT) reduces morbidity and mortality among individuals with dyssynchronous systolic heart failure (HF). However, patient outcomes vary, with some at higher risk than others for HF progression and death.
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The serum cTnT concentration was equal to or more than the detection threshold (0.003 ng/ml) in all patients. The serum cTnT concentration was equal to or more than the cut-off value of 0.014 ng/ml in 46% of patients. By multiple variable analysis, left ventricular (LV) end-diastolic pressure (EDP; adjusted coefficient = 0.014; 95% CI 0.0003–0.029; P = 0.046) was positively correlated, while hemoglobin (adjusted coefficient = −0.079; 95% CI −0.140 to −0.018; P = 0.012), estimated glomerular filtration rate (adjusted coefficient = −0.008; 95% CI −0.013 to −0.003; P = 0.004), and LV ejection fraction (EF; adjusted coefficient = −0.011; 95% CI −0.018 to −0.003; P = 0.004) were negatively correlated with hs-cTnT concentrations.
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Our analysis suggest that the yield of cTn to identify patients with cardiac syncope or acute myocardial infarction is limited.11,37 Elevation of cTn levels is predictive for adverse outcome during long-term follow-up in various patient populations.31,38-41 This could not be shown in our cohort for patients presenting with syncope.
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Clinical InvestigationCongestive Heart FailurePrognostic value of cardiac troponin T in patients with moderate to severe heart failure scheduled for cardiac resynchronization therapy

Background

Methods

Results

Conclusions

Section snippets

Patients and study protocol

Results

Discussion

Conclusion

J Am Soc Echocardiogr

J Am Coll Cardiol

Am Heart J

J Am Coll Cardiol

J Am Coll Cardiol

MIRACLE Study Group. Multicenter InSync Randomized Clinical Evaluation. Cardiac resynchronization in chronic heart failure

N Engl J Med

Comparison of Medical Therapy, Pacing, and Defibrillation in Heart Failure (COMPANION) Investigators

N Engl J Med

Echocardiographic modeling of cardiac dyssynchrony before and during multisite stimulation: a prospective study

Pacing Clin Electrophysiol

Critical appraisal of methods to assess mechanical dyssynchrony

Curr Opin Cardiol

Apoptosis in the failing human heart

N Engl J Med

Prevalence and determinants of troponin T elevation in the general population

Circulation

Persistently increased serum concentrations of cardiac troponin T in patients with idiopathic dilated cardiomyopathy are predictive of adverse outcomes

Circulation

Clinical Investigation
Congestive Heart Failure
Prognostic value of cardiac troponin T in patients with moderate to severe heart failure scheduled for cardiac resynchronization therapy