Serial changes in high‐sensitive troponin I predict outcome in patients with decompensated heart failure

Aims The aim of this study was to evaluate the prognostic utility of small troponin I (TnI) elevations, serial TnI measurements, and the combination of TnI and brain natriuretic peptide (BNP) in patients with decompensated heart failure (HF). Methods and results One hundred and forty‐four patients with acute HF were followed from admission to 90 days post‐discharge. Primary endpoints were all cause mortality and HF‐related readmission. Troponin I and BNP levels were checked on admission, discharge, and up to four consecutive days during hospitalization. A discharge TnI cut‐off of 23.25 ng/L and discharge BNP cut‐off of 360 ng/L were determined by receiver operator characteristic (ROC). Troponin I above 23.25 ng/L is associated with increased risk for mortality and readmission ( P = 0.003). Comparing with TnI quartile 1, TnI quartiles 2–4 had increased mortality and readmission, P = 0.019, P = 0.007, P = 0.014, respectively. Compared with patients with low TnI+low BNP, increased mortality and readmission were seen in patients with high TnI+high BNP ( P = 0.007), high TnI+low BNP ( P = 0.015), and low TnI+high BNP ( P = 0.042). Patients with increasing TnI during treatment had increased mortality compared with patients with stable or decreasing TnI ( P = 0.047). In multivariate analysis, TnI reached statistical significance ( P = 0.009), while BNP did not. Conclusion This study demonstrates that very small TnI elevations and BNP elevations are associated with increased 90‐day mortality and readmission. When compared by ROC and multivariate analysis, TnI is as good a predictor of mortality and readmission as BNP if not slightly better. Patients with increasing TnI during hospitalization for acute HF had increased risk for 90‐day mortality.