Background:Levels of cTn (cardiac troponin) are frequently elevated in patients with heart failure (HF) and reduced ejection fraction (EF) and correlate with the risk for mortality. However, factors associated with high cTn concentrations and the association with cardiovascular events in patients with HF and preserved EF are unclear.Methods and Results:Of 1767 subjects with symptomatic HF with preserved EF from the Americas part of the TOPCAT trial (Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist Trial), 236 underwent baseline measurements of high-sensitivity (hs) cTnI using the Abbott Architect STAT assay. Baseline factors correlated with hs-cTnI levels were assessed in stepwise linear regression models and the association between hs-cTnI and adjudicated study outcomes was examined in Cox models. The median hs-cTnI concentration at baseline was 6.3 ng/L (interquartile range, 3.4–12.9 ng/L) with levels detectable in 99.2% of patients. Higher hs-cTnI concentrations were associated with male sex, black race, lower estimated glomerular filtration rate and higher NT-proBNP (N-terminal pro-B-type natriuretic peptide) levels. After multivariable adjustment, higher concentrations of hs-cTnI were associated with greater risk for the composite of cardiovascular death or HF hospitalization (69 events during mean follow-up 2.6±1.5 years): hazard ratio 1.42 (95% CI, 1.20–1.69), P<0.001 per doubling of hs-cTnI. Compared with those in the lowest quartile of hs-cTnI, patients in the highest quartile demonstrated a nearly 5-fold higher risk of cardiovascular death and HF hospitalization (hazard ratio 4.85 [1.99–11.83], P=0.001). There was no interaction between hs-cTnI and spironolactone treatment with regard to the primary composite end point (interaction P=0.94).Conclusions:In ambulatory patients with HF with preserved EF, levels of hs-cTnI are higher in male patients with black race, lower estimated glomerular filtration rate, and higher NT-proBNP. As in those with HF and reduced EF, higher hs-cTnI levels are independently associated with risk for cardiovascular death and HF hospitalization.CLINICAL TRIAL REGISTRATION:URL: https://www.clinicaltrials.gov. Unique identifier: NCT00094302.

中文翻译：

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心力衰竭和保留射血分数的患者的心肌肌钙蛋白I和心脏事件的风险

背景：心力衰竭（HF）和射血分数（EF）降低的患者中cTn（心脏肌钙蛋白）的水平经常升高，并且与死亡风险相关。然而，目前尚不清楚与HF和EF保留的HF患者高cTn浓度相关的因素以及与心血管事件的相关性。方法和结果：TOPCAT试验美洲部分的1767例有症状HF并保留EF的HF患者（保留心脏的治疗）功能性心力衰竭（使用醛固酮拮抗剂试验），使用Abbott Architect STAT分析法对236位患者进行了高敏感性（hs）cTnI的基线测量。在逐步线性回归模型中评估与hs-cTnI水平相关的基线因素，并在Cox模型中检查hs-cTnI与审判研究结果之间的关联。基线时，hs-cTnI的中位浓度为6.3 ng / L（四分位间距为3.4-12.9 ng / L），在99.2％的患者中可检测到水平。较高的hs-cTnI浓度与男性，黑人，估计的肾小球滤过率较低和较高的NT-proBNP（N端pro-B型利尿钠肽）水平相关。经过多变量调整后，高浓度的hs-cTnI与心血管死亡或心衰住院的复合风险更高（平均随访2.6±1.5年发生69次事件）：风险比1.42（95％CI，1.20-1.69） ，较低的估计肾小球滤过率和较高的NT-proBNP（N末端pro-B型利钠尿肽）水平。经过多变量调整后，高浓度的hs-cTnI与心血管死亡或心衰住院的复合风险更高（平均随访2.6±1.5年发生69次事件）：风险比1.42（95％CI，1.20-1.69） ，较低的估计肾小球滤过率和较高的NT-proBNP（N末端pro-B型利钠尿肽）水平。经过多变量调整后，高浓度的hs-cTnI与心血管死亡或心衰住院的复合风险更高（平均随访2.6±1.5年发生69次事件）：风险比1.42（95％CI，1.20-1.69） ，每次hs-cTnI加倍，P <0.001。与最低的hs-cTnI四分位患者相比，最高四分位患者的心血管死亡和心衰住院风险增加了近5倍（危险比4.85 [1.99-11.83]，P = 0.001）。在主要复合终点方面，hs-cTnI和螺内酯治疗之间没有相互作用（相互作用P= 0.94）。结论：在非卧床的​​HF患者中，EF保留的男性中，黑人种族的hs-cTnI水平较高，估计的肾小球滤过率较低，NT-proBNP较高。与那些HF和EF降低的患者一样，较高的hs-cTnI水平与心血管死亡和HF住院的风险独立相关。临床试验注册：URL：https://www.clinicaltrials.gov。唯一标识符：NCT00094302。