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Cardiac Troponin I Means Increased Risk of Death in CHFers

July 15, 2003 - Detectable levels of cardiac troponin I
(cTnI) may identify CHFers at high risk for worsening heart
function and death, according to this study. Detectable cTnI
was also linked to high BNP level. Having both high cTnI and
high BNP levels predicted a 12 times increase in risk of
death.

See: http://www.chfpatients.com/tests/bnp.htm
for more on BNP levels.

This study included lots of patients with non-ischemic CHF
and no blocked arteries, so it applies to a wider group of
CHFers in real life.
	Cardiac troponin I is a protein in the heart.
Troponin I and troponin T definitely help predict outcome
in people with acute coronary syndrome. The role of these
blood test results in CHFers is not certain. CHFers with
symptoms often have high cardiac troponin levels.

See http://www.chfpatients.com/glossary.htm#acs
for more on acute coronary syndrome.

Researchers studied 238 patients (170 male and 68 female)
with advanced CHF. Half were class 4 at the time. All-cause
death or need for urgent transplant was the primary end
point.
	The cTnI test can detect as little as 0.04 ng/mL.
Detectable levels were found in 117 patients (49%). There
were 29 deaths during the trial. Thirty-five patients got
an urgent heart transplant.
	 Relative risk of death or need for urgent
transplant was double in patients with detectable cTnI (42
versus 22 in no-cTnI patients). Detectable cTnI level was
seen more often in patients who died or needed transplant
than in surviving CHFers.
	Considering both BNP level and cTnI made more
accurate predictions (BNP was measured in 98 patients at
study start). Patients with detectable cTnI and BNP over
485 pg/mL had a 12-times increase in risk of death compared
to patients without detectable cTnI and with BNP less than
485 pg/mL.
	In 58 patients followed up with echos, patients with
detectable levels of cTnI were more likely to have worsening
heart function - 44% had decreased EF versus 18% of patients
without detectable cTnI levels.

It is unknown why cTnI levels are higher in more seriously
ill CHFers. Some studies suggest that cTnI increases any
time the heart's ventricular wall is stressed - like when
the heart enlarges during CHF.
	Researcher Fonarow said, "We think this is the first
step toward a multimarker strategy for evaluating patients
with HF." Hopefully, combining blood test results will help
doctors identify patients at highest risk so their therapy
can be more aggressive.
	Since * any * detectable cTnI was linked to
increased risk of death, there is no need to figure out how
much is too much at this time.

Title:   Cardiac troponin I is associated with impaired
         hemodynamics, progressive left ventricular
         dysfunction, and increased mortality rates in
         advanced heart failure.
Authors: Horwich TB, Patel J, MacLellan WR, Fonarow GC.
Source:  Circulation 2003 Aug 19; 108(7):833-8.