Long‐term cumulative high‐sensitivity cardiac troponin T and mortality among patients with acute heart failure

AIMS: This study aimed to evaluate the cumulative high‐sensitivity cardiac troponin T (hs‐cTNT) from admission to 12 months after discharge and its association with mortality after 12 months among patients with acute heart failure (HF). METHODS: We used data from the China Patient‐Centered Evaluative Assessment of Cardiac Events Prospective Heart Failure Study (China PEACE 5p‐HF Study), which enrolled patients hospitalized primarily for HF from 52 hospitals between 2016 and 2018. We included patients who survived within 12 months and had hs‐cTNT data at admission (within 48 h of admission) and 1 and 12 months after discharge. To evaluate the long‐term cumulative hs‐cTNT, we calculated cumulative hs‐cTNT levels and cumulative times of high hs‐cTNT level. Patients were divided into groups according to the quartiles of cumulative hs‐cTNT levels (Quartiles 1–4) and cumulative times of high hs‐cTNT levels (0–3 times). Multivariable Cox models were constructed to examine the association of cumulative hs‐cTNT with mortality during the follow‐up period. RESULTS: We included 1137 patients with a median age of 64 [interquartile range (IQR), 54–73] years; 406 (35.7%) were female. The median cumulative hs‐cTNT level was 150 (IQR, 91–241) ng/L*month. Based on the cumulative times of high hs‐cTNT levels, 404 (35.5%) patients were with zero time, 203 (17.9%) with one time, 174 (15.3%) with two times, and 356 (31.3%) with three times. During a median follow‐up of 4.76 (IQR, 4.25–5.07) years, 303 (26.6%) all‐cause deaths occurred. The increasing cumulative hs‐cTNT level and cumulative times of high hs‐cTNT level were independently associated with excess all‐cause mortality. Compared with Quartile 1 group, Quartile 4 had the highest hazard ratio (HR) of all‐cause mortality [4.14; 95% confidence interval (CI): 2.51–6.85], followed by Quartile 3 (HR: 3.35; 95% CI: 2.05–5.48) and Quartile 2 (HR: 2.47; 95% CI: 1.49–4.08) groups. Similarly, taking the patients with zero time of high hs‐cTNT level as the reference, the HRs were 1.60 (95% CI: 1.05–2.45), 2.61 (95% CI: 1.76–3.87), and 2.86 (95% CI: 1.98–4.14) in patients who had one, two, and three times of high hs‐cTNT level, respectively. CONCLUSIONS: Elevated cumulative hs‐cTNT from admission to 12 months after discharge was independently associated with mortality after 12 months among patients with acute HF. Repeated measurements of hs‐cTNT after discharge may help monitor the cardiac damage and identify patients with high risk of death.