Cardiac troponin and outcome in decompensated heart failure with preserved ejection fraction

Background: Cardiac troponin (cTn) has been established as an effective prognostic marker in acute heart failure (HF) with predominantly reduced ejection fraction. However, its prognostic value in heart failure with preserved ejection fraction (HFpEF) is unclear. The aim of this study is to describe the prognostic role of troponin I in patients hospitalized for HFpEF decompensation. Methods: We included 363 consecutive patients admitted for HFpEF decompensation that was not associated with acute coronary syndrome (ACS). Patients with troponin level elevation (troponin I level >= 0.04 ng/mL) were compared to patients with normal troponin level. The primary outcome was short-,intermediate-, and long-term all-cause mortality. The secondary outcomes were differences in B-type natriuretic peptide level (BNP), length of stay, and readmission rates between the two groups. Results: Nearly half of the patients in the Cohort had troponin level elevation. Troponin level elevation was significantly associated with higher 30-day (4.8% vs. 0.6%, P=0.014), 1-year (12.2% vs. 4.6%, P=0.009), and 2-year mortality (13.8% vs. 5.1%, P=0.005) when compared to a normal troponin level. Troponin level elevation was an independent predictor of mortality after adjusting for clinical and laboratory risk factors seen in HFpEF decompensation. Additionally, BNP level >287 pg/mL, age, and history of atrial fibrillation were identified as statistically significant predictors of mortality. Conclusions: Troponin level elevation, in hospitalized patients with HFpEF decompensation, was associated with higher short-, intermediate-, and long-term mortality.