Prognostic Impact of High-Sensitive Troponin T Assessment in Elderly Patients With Chronic Heart Failure: Results From the CORONA Trial

Study Questions:

What is the incremental prognostic value of high-sensitive troponin T (hs-cTnT) in heart failure (HF) beyond that of high-sensitivity C-reactive protein (hs-CRP) and N-terminal pro–B-type natriuretic peptide (NT-proBNP) in a subgroup of patients from the CORONA (Controlled Rosuvastatin Multinational Trial in HF) study?

Methods:

Hs-cTnT as a risk factor for the primary endpoint (cardiovascular [CV] death, nonfatal myocardial infarction, nonfatal stroke; n = 356), as well as all-cause mortality (n = 366), CV mortality (n = 299), and the composite of CV mortality and hospitalization from worsening of HF (n = 465) was investigated in 1,245 patients (ages ≥60 years, New York Heart Association [NYHA] class II-IV, ischemic systolic HF) randomly assigned to 10 mg rosuvastatin or placebo.

Results:

In multivariable analyses, adjusting for left ventricular ejection fraction, NYHA class, age, body mass index, diabetes, sex, intermittent claudication, heart rate, estimated glomerular filtration rate, apolipoprotein B (ApoB)/ApoA-1-ratio, NT-proBNP, hs-CRP, and hs-cTnT (both dichotomized according to the 99th percentile and as a continuous variable) was associated with all endpoints (primary endpoint: hazard ratio [HR], 1.87 and 1.51, respectively, per standard deviation change, p < 0.001; all other endpoints: HR, 1.39-1.70). However, improved discrimination as assessed by C-statistics was only seen for the primary endpoint and all-cause mortality.

Conclusions:

The authors concluded that elevated hs-cTnT levels provide strong and independent prognostic information in older patients with chronic ischemic HF.

Perspective:

This study suggests that elevated hs-cTnT levels have a strong predictive and discriminating value for the primary endpoint, all-cause mortality, CV mortality, and the composite of CV mortality and hospitalizations due to worsening of HF, among older patients with chronic HF of ischemic origin. Importantly, changes in hs-cTnT provided inferior prognostic information than that of elevated baseline levels in the present study. Baseline hs-cTnT levels may help clinicians in determining prognosis as part of a multicomponent assessment in elderly patients with HF.

Clinical Topics: Dyslipidemia, Heart Failure and Cardiomyopathies, Vascular Medicine, Lipid Metabolism, Statins, Acute Heart Failure, Heart Failure and Cardiac Biomarkers

Keywords: Fluorobenzenes, Intermittent Claudication, Myocardial Infarction, Stroke, Chronic Disease, Troponin T, Apolipoprotein A-I, Pyrimidines, Risk Factors, Heart Rate, New York, Systole, Prognosis, Cytoskeletal Proteins, C-Reactive Protein, Body Mass Index, Biological Markers, Heart Failure, Stroke Volume, Glomerular Filtration Rate, Diabetes Mellitus, Sulfonamides, Natriuretic Peptide, Brain


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