Usefulness of High-Sensitivity Troponin I in Risk Stratification and Final Disposition of Patients with Acute Heart Failure in the Emergency Department: Comparison between HFpEF vs. HFrEF
Luca Crisanti,
Gabriele Valli,
Elisa Cennamo,
Alessandro Capolino,
Paolo Fratini,
Claudio Cesaro,
Gloria Adducchio,
Antonio De Magistris,
Ferdinando Terlizzi,
Maria Pia Ruggieri,
Enrico Mirante,
Claudio Savoriti,
Kalyarat Sukruang,
Valentina Valeriano,
Francesco Rocco Pugliese,
Francesco Travaglino,
Salvatore Di Somma
Affiliations
Luca Crisanti
Postgraduate School of Emergency Medicine, Sapienza University of Rome, 00189 Rome, Italy
Gabriele Valli
Department of Emergency Medicine, San Giovanni Addolorata Hospital, 00184 Rome, Italy
Elisa Cennamo
Postgraduate School of Emergency Medicine, Sapienza University of Rome, 00189 Rome, Italy
Alessandro Capolino
Postgraduate School of Emergency Medicine, Sapienza University of Rome, 00189 Rome, Italy
Paolo Fratini
Postgraduate School of Emergency Medicine, Sapienza University of Rome, 00189 Rome, Italy
Claudio Cesaro
Postgraduate School of Emergency Medicine, Sapienza University of Rome, 00189 Rome, Italy
Gloria Adducchio
Postgraduate School of Emergency Medicine, Sapienza University of Rome, 00189 Rome, Italy
Antonio De Magistris
Postgraduate School of Emergency Medicine, Sapienza University of Rome, 00189 Rome, Italy
Ferdinando Terlizzi
Postgraduate School of Emergency Medicine, Sapienza University of Rome, 00189 Rome, Italy
Maria Pia Ruggieri
Department of Emergency Medicine, San Giovanni Addolorata Hospital, 00184 Rome, Italy
Enrico Mirante
Department of Emergency Medicine, Sant’Eugenio Hospital, 00144 Rome, Italy
Claudio Savoriti
Department of Emergency Medicine, Sant’Eugenio Hospital, 00144 Rome, Italy
Kalyarat Sukruang
Department of Family Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
Valentina Valeriano
Department of Emergency Medicine, Sandro Pertini Hospital, 00157 Rome, Italy
Francesco Rocco Pugliese
Department of Emergency Medicine, Sandro Pertini Hospital, 00157 Rome, Italy
Francesco Travaglino
Department of Emergency Medicine, University Campus Biomedico of Rome, 00128 Rome, Italy
Salvatore Di Somma
Postgraduate School of Emergency Medicine, Sapienza University of Rome, 00189 Rome, Italy
Background and Objectives: In patients with acute heart failure (AHF), there is no definite evidence on the relationship between high-sensitivity cardiac troponin (hs-cTnI) and the left ventricular ejection fraction (LVEF) comparing the reduced and preserved EF conditions. Materials and Methods: Between January and April 2022, we retrospectively analyzed the data from 386 patients admitted to the emergency departments (ED) of five hospitals in Rome, Italy, for AHF. The criteria for inclusion were a final diagnosis of AHF; a cardiac ultrasound and hs-cTnI evaluations in the ED; and age > 18 yrs. We excluded patients with acute coronary syndrome (ACS). Based on echocardiography and hs-cTnI evaluations, the patients were grouped for (1) preserved (HFpEF) or (2) reduced LVEF (HFrEF) and a a) negative (within the normal range value) or b) positive (above the normal range value) of hs-cTnI, respectively. Results: There was a significant negative relationship between a positive test for hs-cTnI and LVEF. When compared to the group with a negative hs-cTnI test, the patients with a positive test, both from the HFpEF and HFrEF subgroups, were significantly more likely to have an adverse outcome, such as being admitted to the intensive care unit (ICU) or dying in the ED. Moreover, a reduced ejection fraction was linked with a final disposition to a higher level of care. Conclusions: In patients admitted to the ED for AHF without ACS, there is a negative relationship between hs-cTnI and a reduced LVEF, although a significant percentage of patients with a preserved LVEF also resulted to have high levels of hs-cTnI. In the absence of ACS, hs-cTnI seems to be a reliable biomarker of myocardial injury in AHF in the ED and should be considered as a risk stratification parameter for these subjects regardless of the left ventricular function. Further larger prospective studies are needed to confirm these preliminary data.
