Relation between cardiac troponin I and mortality in acute decompensated heart failure

BACKGROUND: 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. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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.