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Internal and emergency medicine · 2025

Troponin predicts mortality in heart failure-related cardiogenic shock.

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Beer Benedikt N, Sundermeyer Jonas, Besch Lisa, Dettling Angela, Kriz Marvin, Kirchhof Paulus, Blankenberg Stefan, Bertoldi Letizia, Dauw Jeroen, Westenfeld Ralf, Horn Patrick, Kelham Matthew, Luedike Peter, Luesebrink Enzo, Orban Martin, Scherer Clemens, Mangner Norman, Morici Nuccia, Villanova Luca, Sramko Marek, Pazdernik Michal, Proudfoot Alastair, Schwinger Robert H G, Wechsler Antonia, Pauschinger Matthias, Eckner Dennis, Graf Tobias, Maniuc Octavian, Nordbeck Peter, Moebius-Winkler Sven, Skurk Carsten, Thiele Holger, Westermann Dirk, Schrage Benedikt

Аннотация

BACKGROUND: In patients with cardiogenic shock (CS), predicting risk of mortality may improve treatment allocation beyond intensive care admission and thereby outcomes. Troponin appears to be a suitable biomarker but has primarily been evaluated in the setting of infarct-related CS, not in heart failure-related CS (HF-CS), which accounts for almost 50% of cases.

OBJECTIVES: To assess the association of Troponin T with shock severity and mortality in HF-CS patients.

METHODS: Heart failure-related CS patients treated in 15 tertiary care centres (5 European countries, 2016-2021) were retrospectively enrolled (NCT03313687). Association of baseline high-sensitive Troponin T and its 24-h kinetics with shock severity according to the SCAI classification and with in-hospital mortality was assessed by fitting multivariable adjusted regression models.

RESULTS: N = 477 patients (mean age 62 years, 30.2% women). High-sensitive Troponin T at baseline (median 164 ng/l) was significantly associated with in-hospital mortality (HR 1.008, 95%CI 1.002-1.013, p < 0.01). Increasing Troponin within 24 h from baseline indicated a 2.4-fold higher risk of death vs. decreasing Troponin levels (HR 2.439, 95% CI 1.070-5.558, p = 0.03). In addition, higher Troponin T levels correlate with higher SCAI stages (e.g., baseline Troponin T per 250 ng/l increase: OR 5.268, 95%CI: 1.637, 16.953, p < 0.01 for SCAI stage D vs. C).

CONCLUSIONS: Troponin T, a marker of myocardial injury, associates with shock severity in patients with heart failure-related CS. It predicts mortality both with its baseline value as well as with its 24-h kinetics. Thus, Troponin may be a suitable marker to guide therapy or clinical trial enrolment in these patients.