The Prognostic Value of Troponin Levels Adjusted for Renal Function in Heart Failure - A Systematic Review.

Introduction: Heart failure (HF) is a significant global health issue associated with high morbidity and mortality. Accurate biomarkers are crucial for predicting adverse outcomes and informing management. High-sensitivity cardiac troponins T (hs-cTnT) and I (hs-cTnI) are important prognostic indicators in HF, though their predictive value can be affected by comorbidities, particularly renal dysfunction.

Objectives: This review evaluates the prognostic significance of troponin adjusted for renal function in patients with HF.

Methods: A comprehensive literature search was performed in PubMed, including studies from 2011 to September 2024, using specific MeSH terms related to HF, troponin, and prognosis.

Results: Thirty-two studies met the inclusion criteria, all indicating an association between troponin levels adjusted for renal function and cardiovascular mortality in HF patients (HR 1.67-3.22). High-sensitivity cardiac troponins T (hs-cTnT) and I (hs-cTnI) are independent predictors of cardiovascular mortality in acute heart failure (AHF). Increasing hs-cTnI levels, with a baseline threshold of 0.03 ng/mL, significantly correlate with mortality risk (P = .0011). Patients with hs-cTnT > 14 ng/L, > 21.5 ng/L, and > 26.5 ng/L exhibit increased all-cause mortality after adjusting for renal function. Despite these associations, the role of troponin in predicting heart failure readmissions remains inconsistent, indicating that elevated troponin levels do not reliably predict rehospitalization risk, particularly in those with advanced renal impairment.

Conclusions: High-sensitivity troponins (hs-cTnT and hs-cTnI) are independent predictors of mortality in heart failure, even after accounting for renal function, while their role in predicting hospitalizations is weaker.