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(Circulation. 2007;116:1242-1249.)
© 2007 American Heart Association, Inc.

Heart Failure

Prognostic Value of Very Low Plasma Concentrations of Troponin T in Patients With Stable Chronic Heart Failure

Roberto Latini, MD; Serge Masson, PhD; Inder S. Anand, MD; Emil Missov, MD; Marjorie Carlson, BS; Tarcisio Vago, BiolD; Laura Angelici, MS; Simona Barlera, MS; Giovanni Parrinello, PhD; Aldo P. Maggioni, MD; Gianni Tognoni, MD; Jay N. Cohn, MD, for the Val-HeFT Investigators

From the Department of Cardiovascular Research, Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy (R.L., S.M., L.A., S.B.); Department of Medicine, New York Medical College, Valhalla, NY (R.L.); Cardiology Section, Veterans Affairs Medical Center, Minneapolis, Minn (I.S.A.); Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis (E.M., M.C., J.N.C.); Endocrinology Laboratory, Ospedale Luigi Sacco, Milan, Italy (T.V.); Section of Medical Statistics, University of Brescia, Brescia, Italy (G.P.); Centro Studi ANMCO, Florence, Italy (A.P.M.); and Consorzio Mario Negri Sud, S. Maria Imbaro, Italy (G.T.).

Correspondence to Roberto Latini, MD, Istituto Mario Negri, via La Masa 19, 20156 Milano, Italy. E-mail latini{at}marionegri.it

Received August 1, 2006; accepted June 11, 2007.

Background— Circulating cardiac troponin T, a marker of cardiomyocyte injury, predicts adverse outcome in patients with heart failure (HF) but is detectable in only a small fraction of those with chronic stable HF. We assessed the prognostic value of circulating cardiac troponin T in patients with stable chronic HF with a traditional (cTnT) and a new precommercial highly sensitive assay (hsTnT).

Methods and Results— Plasma troponin T was measured in 4053 patients with chronic HF enrolled in the Valsartan Heart Failure Trial (Val-HeFT). Troponin T was detectable in 10.4% of the population with the cTnT assay (detection limit 0.01 ng/mL) compared with 92.0% with the new hsTnT assay (0.001 ng/mL). Patients with cTnT elevation or with hsTnT above the median (0.012 ng/mL) had more severe HF and worse outcome. In Cox proportional hazards models adjusting for clinical risk factors, cTnT was associated with death (780 events; hazard ratio=2.08; 95% confidence interval, 1.72 to 2.52; P<0.0001) and first hospitalization for HF (655 events; hazard ratio=1.55; 95% confidence interval, 1.25 to 1.93; P<0.0001). HsTnT was associated with the risk of death in unadjusted analysis for deciles of concentrations and in multivariable models (hazard ratio=1.05; 95% confidence interval, 1.04 to 1.07 for increments of 0.01 ng/mL; P<0.0001). Addition of hsTnT to well-calibrated models adjusted for clinical risk factors, with or without brain natriuretic peptide, significantly improved prognostic discrimination (C-index, P<0.0001 for both outcomes).

Conclusions— In this large population of patients with HF, detectable cTnT predicts adverse outcomes in chronic HF. By the highly sensitive assay, troponin T retains a prognostic value at previously undetectable concentrations.

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