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Original Investigation
February 2017

Factors Associated With and Prognostic Implications of Cardiac Troponin Elevation in Decompensated Heart Failure With Preserved Ejection FractionFindings From the American Heart Association Get With The Guidelines–Heart Failure Program

Author Affiliations
  • 1Division of Cardiology, University of Texas Southwestern Medical Center, Dallas
  • 2Division of Cardiology, University of Louisville School of Medicine, Louisville, Kentucky
  • 3Duke Clinical Research Institute, Durham, North Carolina
  • 4Associate Editor, JAMA Cardiology
  • 5Brigham and Women’s Hospital Heart & Vascular Center and Harvard Medical School, Boston, Massachusetts
  • 6Division of Cardiology, Stanford University, Palo Alto, California
  • 7Division of Cardiology, Northwestern University, Chicago, Illinois
  • 8Deputy Editor, JAMA Cardiology
  • 9Ronald Reagan–UCLA Medical Center, Los Angeles, California
  • 10Associate Editor for Health Care Quality and Guidelines, JAMA Cardiology
JAMA Cardiol. 2017;2(2):136-145. doi:10.1001/jamacardio.2016.4726
Key Points

Question  What are the prognostic implications of elevated troponin levels among patients with decompensated heart failure and preserved ejection fraction (HFpEF)?

Findings  In this observational cohort study, abnormally elevated troponin levels in patients with decompensated HFpEF were associated with higher risk of in-hospital and postdischarge adverse outcomes, independent of other risk predictors.

Meaning  Assessment of troponin levels among patients with decompensated HFpEF may have important prognostic value independent of other established clinical predictors.


Importance  Elevated levels of cardiac troponins are associated with adverse clinical outcomes among patients with heart failure (HF) and reduced ejection fraction. However, the clinical significance of troponin elevation in the setting of decompensated HF with preserved ejection fraction (HFpEF) is not well established.

Objective  To determine the clinical predictors of troponin elevation and its association with in-hospital and long-term outcomes among patients with decompensated HFpEF.

Design, Setting, and Participants  Observational analysis of Get With The Guidelines–HF registry participants who were admitted for decompensated HFpEF (ejection fraction ≥50%) from January 2009 through December 2014 and who had quantitative or categorical (elevated vs normal based on institution’s reference laboratory) measures of troponin level (troponin T or troponin I, as available).

Main Outcomes and Measures  In-hospital outcomes (mortality, length of stay, and discharge destination) and postdischarge outcomes (30-day mortality, 30-day readmission rate, 1-year mortality).

Results  We included 34 233 patients with HFpEF from 224 sites with measured troponin levels (33.4% men; median age, 79 years): 78.6% (n = 26 896) with troponin I and 21.4% (n = 7319) with troponin T measurements. Among these, 22.6% (n = 7732) had elevation in troponin levels. In adjusted analysis, higher serum creatinine level, black race, older age, and ischemic heart disease were associated with troponin elevation. Elevated troponin was associated with higher odds of in-hospital mortality (odds ratio [OR], 2.19; 95% CI, 1.88-2.56), greater length of stay (length of stay >4 days OR, 1.38; 95% CI, 1.29-1.47), and lower likelihood of discharge to home (OR, 0.65; 95% CI, 0.61-0.71) independent of other clinical predictors and measured confounders. Presence of elevated troponin I levels was also significantly associated with increased risk of 30-day mortality (hazard ratio [HR], 1.59; 95% CI, 1.42-1.80), 30-day all-cause readmission (HR, 1.12; 95% CI, 1.01-1.25), and 1-year mortality HR, 1.35; 95% CI, 1.26-1.45).

Conclusions and Relevance  Troponin elevation among patients with acutely decompensated HFpEF is associated with worse in-hospital and postdischarge outcomes, independent of other predictive variables. Future studies are needed to determine if measurement of troponin levels among patients with decompensated HFpEF may be useful for risk stratification.