Prognostic Significance of High-Sensitivity Troponin T in Nonischemic Heart Failure with Reduced Ejection Fraction

OBJECTIVE
Cardiac biomarkers can help diagnose and predict heart failure prognosis. High-sensitivity troponin T has frequently been investigated in ischemic heart failure studies. However, the relation between high-sensitivity troponin T and mortality in nonischemic heart failure and its level indicating poor prognosis remain unclear. This study aimed to show whether high-sensitivity troponin T is a predictor of all-cause mortality and the cut-off value for high-sensitivity troponin T in patients with nonischemic heart failure with reduced ejection fraction.


METHODS
We included 249 nonischemic heart failure patients with left ventricular ejection fraction ≤ 40%, age ≥ 18 years, and high-sensitivity troponin T level known.


RESULTS
Of the patients, 59.8% were male, 73.5% were New York Heart Association I or II, and the median age was 64. High-sensitivity troponin T value of the patients was 18 ng/L [inter-quartile range, 10-34]. The cut-off value of high-sensitivity troponin T for all-cause mortality was 21.5 ng/L, with 72.6% sensitivity and 69.9% specificity (area under the curve: 0.760, 95% CI: 0.692-0.828, P < 0.001). Patients were compared according to the 21.5 ng/L high-sensitivity troponin T cut-off value. At 30-month follow-up, all-cause mortality was 29.3%. According to the Kaplan–Meier analysis, the mortality rate was 14% in the high-sensitivity troponin T < 21.5 ng/L group, while the mortality rate was 50% in the high-sensitivity troponin T ≥ 21.5 ng/L group (P < 0.001, log-rank test). Baseline high-sensitivity troponin T was inde-pendently associated with all-cause mortality in nonischemic heart failure with reduced ejection fraction when adjusted for estimated glomerular filtration rate, hemoglobin, N-terminal pro-brain natriuretic peptide, body mass index, and left atrial diameter (hazard ratio: 1.012, 95% confidence interval: 1.003-1.020, P = 0.005).


CONCLUSION
The high-sensitivity troponin T cut-off value was 21.5 ng/L to predict a worse prognosis in nonischemic heart failure with reduced ejection fraction. There was an independent association between high-sensitivity troponin T and all-cause mortality.