Article ID Journal Published Year Pages File Type
3019210 Revista Española de Cardiología (English Edition) 2008 9 Pages PDF
Abstract

Introduction and objectiveThe usefulness of prolonged troponin-T (TnT) monitoring in outpatients with nonischemic heart failure (HF) is not clear. The aim of this study was to investigate the incidence, prognostic value, and determinants of a raised TnT level.MethodsThe study involved 80 outpatients (age 56[14] years, 69% male) with chronic stable HF (mean left ventricular ejection fraction, 24[9]; 51 in New York Heart Association class II and 29 in class III) of non-ischemic origin, as confirmed with coronary angiography. The TnT level was measured at study entry and at every outpatient visit (median interval, 3.1 months; interquartile range [IQR], 1.8-5.0 months) in a follow-up period of 22.2(10.6) months. Patients were TnT+ if the level was measurable (ie, >0.01 ng/mL).ResultsAt study entry, 7 (9%) patients were TnT+. By 5 years, the cumulative incidence had reached 53%, and the median TnT level was 0.059 ng/mL (IQR, 0.023-0.100 ng/mL; range, 0.013-0.500 ng/mL). Beta-blocker therapy was associated with a reduction in incidence (hazard ratio [HR]=0.220; 95% confidence interval [CI], 0.089-0.540; P =.001) while the incidence increased with the N-terminal probrain natriuretic peptide (NT-proBNP) level (HR=1.005; 95% CI, 1.001-1.010; P =0.021). During follow-up, 14 (17.5%) patients had a cardiac event (ie, 9 cardiac deaths and 5 urgent transplants); these occurred in 12 (50%) of the 24 TnT+ patients versus 2 (3.6%) of the 56 TnT– patients (P <.001). After adjustment, Cox multivariate analysis showed that being TnT+ was a predictor of an adverse event (HR per 0.01 ng/mL=1.359; 95% CI, 1.037-1.782; P =.026), independently of the NT-proBNP level (HR per 500 pg/mL=1.057; 95% CI, 1.023-1.092; P =.001).ConclusionsA measurable TnT level was frequently observed during clinical monitoring of outpatients with non-ischemic HF and indicated a poor prognosis, even when the level was low.

Introducción y objetivosEl valor del seguimiento prolongado de las determinaciones de troponina T (TnT) en pacientes ambulatorios con insuficiencia cardiaca no isquémica no está aclarado. Estudiamos la incidencia de las concentraciones aumentadas de TnT, sus determinantes y su valor pronóstico.MétodosSe incluyó a 80 pacientes ambulatorios (56 ± 14 años; el 69% varones) con insuficiencia cardiaca crónica (fracción de eyección del ventrículo izquierdo, 24% ± 9%), situación estable (NYHA II, 51; NYHA III, 29) y etiología no isquémica confirmada por coronariografía. Los valores de TnT se midieron a la inclusión y en cada visita ambulatoria (mediana, 3,1 [intervalo intercuartílico, 1,8-5] meses), durante un seguimiento de 22,2 ± 10,6 meses. Se definió TnT+ como aquella detectable (> 0,01 ng/ml).ResultadosEn la visita inicial 7 (9%) pacientes presentaban TnT+, y la incidencia acumulada a 5 años alcanzó el 53%, con una mediana de 0,059 (intervalo inter-cuartílico, 0,023-0,1; mínimo, 0,013; máximo, 0,5) ng/ml. La incidencia de TnT+ estuvo disminuida en caso de tratamiento con bloqueadores beta (hazard ratio [HR] = 0,220; intervalo de confianza [IC] del 95%, 0,089-0,540; p = 0,001) y aumentada en relación con el nivel de NT-proBNP (HR = 1,005; IC del 95%, 1,001-1,010; p = 0,021). Presentaron eventos durante el seguimiento 14 (17,5%) pacientes (9 muertes cardiacas y 5 trasplantes urgentes), que ocurrieron en 12 (50%) de 24 con TnT+ frente a 2 (3,6%) de 56 con TnT1– (p < 0,001). Tras el ajuste multivariable de Cox, la aparición de TnT+ fue predictora de eventos adversos (0,01 ng/ml: HR = 1,359; IC del 95%, 1,037-1,782; p = 0,026) con independencia delConclusionesEn el seguimiento ambulatorio de pacientes con insuficiencia cardiaca no isquémica, la aparición de TnT+ es frecuente e identifica un peor pronóstico, incluso con bajas concentraciones.

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