Increased cardiac troponin levels are linked to poor clinical outcomes in patients with heart failure (HF) and a low ejection fraction. However, the clinical significance of troponin increase in decompensated heart failure with preserved ejection fraction (HFpEF) is unknown. For a study, the goal of the researchers was to find out what clinical predictors of troponin elevation are and how they relate to in-hospital and long-term outcomes in patients with decompensated HFpEF. For a study, the researchers wanted to get with the Guidelines–HF registry patients admitted for decompensated HFpEF (ejection fraction more than or equal to  50%) between January 2009 and December 2014 and who had quantitative or categorical (elevated vs normal based on institution’s reference laboratory) troponin level assessments (troponin T or troponin I, as available). In-hospital (mortality, duration of stay, and discharge destination) and post-discharge (mortality, length of stay, and discharge destination) outcomes (30-day mortality, 30-day readmission rate, 1-year mortality). The researchers  included 34,233 HFpEF patients with measured troponin levels from 224 sites (33.4% men; median age, 79 years): 78.6% (n=26,896) had troponin I measures and 21.4% (n=7,319) had troponin T data. Troponin levels were elevated in 22.6% of individuals (n=7,732). Troponin increase was linked to a higher blood creatinine level, black race, older age, and ischemic heart disease in an adjusted practice. Independent of other clinical predictors and measured confounders, elevated troponin was linked to a higher risk of in-hospital mortality (OR, 2.19; 95% Confidence interval, 1.88-2.56), a longer length of stay of more than 4 days(OR, 1.38; 95% confidence interval, 1.29-1.47), and a lower likelihood of discharge to home (OR, 0.65; 95% confidence interval, 0.61-0.71) independent of other clinical predictors and measured confounders. Elevated troponin I levels were also linked to a higher risk of 30-day mortality (HR, 1.59; 95% confidence interval, 1.42-1.80), 30-day all-cause readmission (HR, 1.12; 95% confidence interval, 1.01-1.25), and 1-year mortality (HR, 1.35; 95% confidence interval, 1.26-1.45). Troponin elevation is related to worse in-hospital and post-discharge outcomes in patients with acutely decompensated HFpEF, regardless of other prognostic factors. Future research is needed to see if monitoring troponin levels in patients with decompensated HFpEF can help with risk categorization.

 

Link:jamanetwork.com/journals/jamacardiology/fullarticle/2594260?resultClick=1