Abstract 12726: High-sensitivity Troponin T Concentrations Improve Diagnostic and Prognostic Assessment in Patients With Acute Dyspnea

IntroductionN-terminal pro-B-type natriuretic peptide (NT-proBNP) measurements help diagnose acute heart failure (HF) but with less accuracy in HF patients with preserved ejection fraction (HFpEF). Whether high-sensitivity cardiac troponin-T (hs-cTnT) measurements can improve diagnostic accuracy of HFpEF and provide prognostic information in patients with acute dyspnea is not known.MethodsWe measured hs-cTnT concentrations on admission in 314 patients hospitalized with acute dyspnea and adjudicated diagnoses according to guidelines. HF patients with ejection fraction (EF) ≥50% were diagnosed with HFpEF.ResultsAmong 143 patients (46%) with acute HF, 52 patients were diagnosed with HFpEF. HFpEF patients had lower NT-proBNP concentrations than HF patients with reduced EF (HFrEF)median 2293 (Q1-3 687-4569) vs. 4308 (2064-8738) ng/L, p=0.001. No difference in hs-cTnT concentrations were found between HFpEF and HFrEF patients39 (19-104) vs. 35 (23-74) ng/L, p=0.795. Area under the receiver-operating characteristics curve (ROC-AUC) to separate HFpEF from non-HF-related dyspnea was 0.79 (95% CI 0.73-0.86) for NT-proBNP, 0.80 (0.73-0.86) for hs-cTnT, and 0.83 (0.76-0.89) for hs-cTnT and NT-proBNP in combination. Adding hs-cTnT to a predictive model for HFpEF including NT-proBNP and clinical variables resulted in a net reclassification improvement of 0.51 (95% CI 0.46-0.56, p