Troponin predicts mortality in heart failure-related cardiogenic shock

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

Troponin predicts mortality in heart failure-related cardiogenic shock

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 SramkoMichal 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

Department of Internal Medicine II

Abstract

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.

Original language	English
Journal	Internal and Emergency Medicine
ISSN	1828-0447
Publication status	Published - 2025

Funding

Funders	Funder number
AstraZeneca
Swedish Hjärt-Lungfonden
Korean Society of Heart Failure
Else Kröner-Fresenius-Stiftung	2019_A142
German Research Foundation	535014557
German Center for Cardiovascular Research	81X4710101

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

DFG Research Classification Scheme

2.22-12 Cardiology, Angiology

Cite this

Beer, B. N., Sundermeyer, J., Besch, L., Dettling, A., Kriz, M., Kirchhof, P., Blankenberg, S., Bertoldi, L., Dauw, J., Westenfeld, R., Horn, P., Kelham, M., Luedike, P., Luesebrink, E., Orban, M., Scherer, C., Mangner, N., Morici, N., Villanova, L., ... Schrage, B. (2025). Troponin predicts mortality in heart failure-related cardiogenic shock. Internal and Emergency Medicine.

@article{1aa2c20f14594fd0bd93c2e2e1cf5592,

title = "Troponin predicts mortality in heart failure-related cardiogenic shock",

abstract = "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.",

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

note = "Publisher Copyright: {\textcopyright} The Author(s) 2025.",

year = "2025",

language = "English",

journal = "Internal and Emergency Medicine",

issn = "1828-0447",

publisher = "Springer Science and Business Media Deutschland GmbH",

}

Beer, BN, Sundermeyer, J, Besch, L, Dettling, A, Kriz, M, Kirchhof, P, Blankenberg, S, Bertoldi, L, Dauw, J, Westenfeld, R, Horn, P, Kelham, M, Luedike, P, Luesebrink, E, Orban, M, Scherer, C, Mangner, N, Morici, N, Villanova, L, Sramko, M, Pazdernik, M, Proudfoot, A, Schwinger, RHG, Wechsler, A, Pauschinger, M, Eckner, D, Graf, T, Maniuc, O, Nordbeck, P, Moebius-Winkler, S, Skurk, C, Thiele, H, Westermann, D & Schrage, B 2025, 'Troponin predicts mortality in heart failure-related cardiogenic shock', Internal and Emergency Medicine.

TY - JOUR

T1 - Troponin predicts mortality in heart failure-related cardiogenic shock

AU - Beer, Benedikt N

AU - Sundermeyer, Jonas

AU - Besch, Lisa

AU - Dettling, Angela

AU - Kriz, Marvin

AU - Kirchhof, Paulus

AU - Blankenberg, Stefan

AU - Bertoldi, Letizia

AU - Dauw, Jeroen

AU - Westenfeld, Ralf

AU - Horn, Patrick

AU - Kelham, Matthew

AU - Luedike, Peter

AU - Luesebrink, Enzo

AU - Orban, Martin

AU - Scherer, Clemens

AU - Mangner, Norman

AU - Morici, Nuccia

AU - Villanova, Luca

AU - Sramko, Marek

AU - Pazdernik, Michal

AU - Proudfoot, Alastair

AU - Schwinger, Robert H G

AU - Wechsler, Antonia

AU - Pauschinger, Matthias

AU - Eckner, Dennis

AU - Graf, Tobias

AU - Maniuc, Octavian

AU - Nordbeck, Peter

AU - Moebius-Winkler, Sven

AU - Skurk, Carsten

AU - Thiele, Holger

AU - Westermann, Dirk

AU - Schrage, Benedikt

PY - 2025

Y1 - 2025

N2 - 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.

AB - 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.

UR - https://www.scopus.com/pages/publications/105022420370

UR - https://www.mendeley.com/catalogue/5948749f-0321-3257-ad63-c98cc8485671/

M3 - Journal articles

C2 - 41254464

SN - 1828-0447

JO - Internal and Emergency Medicine

JF - Internal and Emergency Medicine

ER -

Troponin predicts mortality in heart failure-related cardiogenic shock

Abstract

Funding

UN SDGs

DFG Research Classification Scheme

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