High sensitivity Troponins In Patients with elevated prohormone of beta natriuretic peptide and acute heart failure (HIGH TRIP Trial)

In patients presented to emergency rooms, Pro hormone of Natriuretic Peptide (Pro BNP) essay is overly sensitive test to rule out heart failure but less specific in predicting outcomes in follow-ups, in this study we ought to find the added value of High Sensitivity cardiac Troponin I (Hs-cTn I), in patients presented acutely with heart failure and its impact on mortality when Pro BNP is highly elevated. Prospective cohort study, inclusion criteria were age above 18 and clearly positive NT Pro BNP > 1000 pg/ml, with 12 months follow up period, primary end point was mortality from heart failure, secondary endpoint was need for rehospitalization. 95 patients were enrolled, divided into overt and non-overt pulmonary edema groups. Mean (Pro BNP) was 6184 and 5927 pg/ml and mean (Hs-cTn I) were 19.27 and 0.17 ng/ml respectively, Mean Ejection fraction was 48 ± 7 and 47 ± 7 for each group sequentially. Mortality rate was 4 (13%) in the higher Hs-c Tn I group, and 1 (1.6%) in the low troponin level group p = .03, odd ratio was 8.5, 95% CI (0.9–80). Need for re-hospitalization was present in 12 (38%) Vs 7 (8%) patients, p = .0081, odd ratio 4.8, 95% CI (1.7–14.2). In COX proportional hazard analysis, only Hs-cTn I was a significant predictor of poor outcome in this high-risk cohort with p = 0.0001. Adding (Hs-cTrop I) assay to the panel of laboratory testing, in patients presented to ER with acute heart failure and with high Pro-BNP > 1000, may further predicts mortality and rehospitalization rate.