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<p>Background: In patients with cardiogenic shock (CS), predicting risk of mortality may improve treatment allocation beyond intensive care admission and thereby outcomes. Troponin appears to be a suitable biomarker but has primarily been evaluated in the setting of infarct-related CS, not in heart failure-related CS (HF-CS), which accounts for almost 50% of cases. <i>Objectives:</i> To assess the association of Troponin T with shock severity and mortality in HF-CS patients. <i>Methods:</i> Heart failure-related CS patients treated in 15 tertiary care centres (5 European countries, 2016–2021) were retrospectively enrolled (NCT03313687). Association of baseline high-sensitive Troponin T and its 24-h kinetics with shock severity according to the SCAI classification and with in-hospital mortality was assessed by fitting multivariable adjusted regression models. <i>Results:</i> <i>N</i> = 477 patients (mean age 62&#xa0;years, 30.2% women). High-sensitive Troponin T at baseline (median 164&#xa0;ng/l) was significantly associated with in-hospital mortality (HR&#xa0;1.008, 95%CI 1.002–1.013, <i>p</i> &lt; 0.01). Increasing Troponin within 24&#xa0;h from baseline indicated a 2.4-fold higher risk of death vs. decreasing Troponin levels (HR&#xa0;2.439, 95%&#xa0;CI 1.070–5.558, <i>p</i> = 0.03). In addition, higher Troponin T levels correlate with higher SCAI stages (e.g., baseline Troponin T per 250&#xa0;ng/l increase: OR 5.268, 95%CI: 1.637, 16.953, <i>p</i> &lt; 0.01 for SCAI stage D vs. C). <i>Conclusions:</i> Troponin T, a marker of myocardial injury, associates with shock severity in patients with heart failure-related CS. It predicts mortality both with its baseline value as well as with its 24-h kinetics. Thus, Troponin may be a suitable marker to guide therapy or clinical trial enrolment in these patients.</p> Graphical abstract <p>Central Illustration. Baseline Troponin and its 24-hour kinetics predict all-cause in-hospital mortality in patients with heart failure-related cardiogenic shock. In addition, Troponin associates with shock severity according to the SCAI classification. SCAI: Society for Cardiovascular Angiography and Interventions.</p>

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Troponin predicts mortality in heart failure-related cardiogenic shock

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  • 发表日期：

    2025年11月18日

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  • Benedikt N. Beer,
  • Jonas Sundermeyer,
  • Lisa Besch,
  • Angela Dettling,
  • Marvin Kriz,
  • Paulus Kirchhof,
  • Stefan Blankenberg,
  • Letizia Bertoldi,
  • Jeroen Dauw,
  • Ralf Westenfeld,
  • Patrick Horn,
  • Matthew Kelham,
  • Peter Luedike,
  • Enzo Luesebrink,
  • Martin Orban,
  • Clemens Scherer,
  • Norman Mangner,
  • Nuccia Morici,
  • Luca Villanova,
  • Marek Sramko,
  • Michal Pazdernik,
  • Alastair Proudfoot,
  • Robert H. G. Schwinger,
  • Antonia Wechsler,
  • Matthias Pauschinger,
  • Dennis Eckner,
  • Tobias Graf,
  • Octavian Maniuc,
  • Peter Nordbeck,
  • Sven Moebius-Winkler,
  • Carsten Skurk,
  • Holger Thiele,
  • Dirk Westermann,
  • Benedikt Schrage

摘要

Background: In patients with cardiogenic shock (CS), predicting risk of mortality may improve treatment allocation beyond intensive care admission and thereby outcomes. Troponin appears to be a suitable biomarker but has primarily been evaluated in the setting of infarct-related CS, not in heart failure-related CS (HF-CS), which accounts for almost 50% of cases. Objectives: To assess the association of Troponin T with shock severity and mortality in HF-CS patients. Methods: Heart failure-related CS patients treated in 15 tertiary care centres (5 European countries, 2016–2021) were retrospectively enrolled (NCT03313687). Association of baseline high-sensitive Troponin T and its 24-h kinetics with shock severity according to the SCAI classification and with in-hospital mortality was assessed by fitting multivariable adjusted regression models. Results: N = 477 patients (mean age 62 years, 30.2% women). High-sensitive Troponin T at baseline (median 164 ng/l) was significantly associated with in-hospital mortality (HR 1.008, 95%CI 1.002–1.013, p < 0.01). Increasing Troponin within 24 h from baseline indicated a 2.4-fold higher risk of death vs. decreasing Troponin levels (HR 2.439, 95% CI 1.070–5.558, p = 0.03). In addition, higher Troponin T levels correlate with higher SCAI stages (e.g., baseline Troponin T per 250 ng/l increase: OR 5.268, 95%CI: 1.637, 16.953, p < 0.01 for SCAI stage D vs. C). Conclusions: Troponin T, a marker of myocardial injury, associates with shock severity in patients with heart failure-related CS. It predicts mortality both with its baseline value as well as with its 24-h kinetics. Thus, Troponin may be a suitable marker to guide therapy or clinical trial enrolment in these patients.

Graphical abstract

Central Illustration. Baseline Troponin and its 24-hour kinetics predict all-cause in-hospital mortality in patients with heart failure-related cardiogenic shock. In addition, Troponin associates with shock severity according to the SCAI classification. SCAI: Society for Cardiovascular Angiography and Interventions.