Dr. David D. Berg is a cardiologist connected with Brigham and Women's Hospital in Boston, Massachusetts. He graduated from Harvard Medical School with a medical degree. In this video Dr. Berg discusses Serial Assessment of High-Sensitivity Cardiac Troponin and the Effect of Dapagliflozin in Patients with Heart Failure with Reduced Ejection Fraction: An Analysis of the DAPA-HF Trial.
Link to Abstract-
Abstract: Higher levels of circulating high-sensitivity cardiac troponin T (hsTnT) are linked to a higher risk of worsening heart failure (HF) and death in individuals with HF with reduced ejection fraction (HFrEF). The prognostic importance of changes in hsTnT over time, the effects of dapagliflozin on clinical outcomes compared to baseline hsTnT levels, and the influence of dapagliflozin on hsTnT levels are all areas where more research is needed.
DAPA-HF was a randomized, double-blind, placebo-controlled trial of dapagliflozin (10 mg daily) in NYHA class II-IV patients with a left ventricular ejection fraction of less than 40% (median follow-up = 18.2 months). hsTnT (Roche Diagnostics) was tested in 3,112 patients at baseline and 2,506 patients after a year. The primary outcome was determined to be worsening HF or death from cardiovascular causes. Clinical outcomes were assessed based on baseline hsTnT and change in hsTnT over a year. Baseline hsTnT was used to compare the impact of dapagliflozin vs. placebo on clinical outcomes. Dapagliflozin's influence on hsTnT was investigated.
The median hsTnT concentration at baseline was 20.0 (25th-75th percentile, 13.7-30.2) ng/L. Over the course of a year, 67.9% of patients experienced a 10% relative increase or decrease in hsTnT concentrations, whereas 43.5 percent experienced a 20% relative change. Across increasing quartiles of baseline hsTnT concentration, a stepwise gradient of greater risk for the primary endpoint was seen (adjusted hazard ratio [aHR] Q4 vs. Q1, 5.10; 95 percent CI, 3.67-7.08). Over the course of a year, both relative and absolute increases in hsTnT were linked to a higher risk of the primary outcome. The absolute risk reduction with dapagliflozin was consistent across quartiles of baseline hsTnT (p-interaction = 0.55), while patients in the top quartile had the greatest relative risk decrease (absolute risk difference, 7.5 percent ; 95 percent CI, 1.0 percent - 14.0 percent ). When compared to placebo, dapagliflozin tended to reduce the increase in hsTnT over time (relative least squares mean reduction, 3% [-6 percent to 0%]; p=0.076).
Conclusions: A higher baseline hsTnT and a bigger year-over-year increase in hsTnT are linked to poor clinical outcomes. Regardless of baseline hsTnT levels, dapagliflozin consistently lowered the risk of the primary outcome.