Indexed on: 27 Mar '07Published on: 27 Mar '07Published in: American Heart Journal
Troponin level elevations are common in patients with acute decompensated heart failure (ADHF), yet their prognostic value above and beyond traditional predictors of outcomes in heart failure is uncertain.In the EFFECT study, we determined the association between cardiac troponin I and all-cause mortality in 2025 patients hospitalized for heart failure in Ontario, Canada, between April 1, 1999, and March 31, 2001.Cardiac troponin I levels >0.5 microg/L (median 1.7 microg/L, interquartile range 0.9-4.8 microg/L) occurred in 699 (34.5%) patients and was an independent predictor of mortality (adjusted hazard ratio 1.49, 95% CI 1.25-1.77, P < .001). Furthermore, we observed a dose-response relationship between cardiac troponin I and mortality that persisted after adjustment for potential confounding factors (adjusted hazard ratio 1.10 per 1 microg/L increase, 95% CI 1.05-1.15, P < .001). The association between cardiac troponin I and mortality was similar for patients with and without other features of acute ischemia on presentation (P > .05 for interaction).In patients hospitalized for ADHF who had cardiac troponin levels measured during the course of clinical practice, cardiac troponin I was an independent predictor of all-cause mortality. Cardiac troponin testing is easily accessible, has predictive value above and beyond traditional clinical predictors of mortality, and may help guide medical decision making in patients with ADHF.