The association of Hs-Troponin I with cardiac dysfunction and structural changes in chronic heart failure with reduced ejection fraction patients

Introduction: Cardiomyocyte death is the key pathological feature of heart failure with reduced ejection fraction (HFrEF). One of the circulating markers which represent myocardial cell death is cardiac troponin. High sensitivity-troponin I (hsTnI) has been validated as an acute coronary syndrome diagnostic criteria. But its value and role in chronic heart failure, specifically HFrEF, has been variable in different studies. The aim of this study was to determine whether hs-TnI, an indicator of cardiomyocyte injury, is associated with functional and structural changes in HFrEF patients. Methods: A hospital-based cross-sectional analytic study was conducted on 72 patients with stable chronic HFrEF between April and October 2022. All subjects underwent echocardiography (Philips EPIQ7 and Affinity 70) and hs-troponin I serum measurement (Abbott Architect assay). Spearman's test was used to evaluate the correlation between hs-troponin I and left ventricular ejection fraction (LVEF), E/A ratio, left ventricular end-diastolic volume (LVEDV), tricuspid annular plane systolic excursion (TAPSE) and left atrial volume index (LAVI). Results: hs-TnI concentrations were quantifiable in all samples ranging from 10 to 280.9 pg/mL. hs-TnI was associated significantly with LVEF (r=-0.39; p<0.01), E/A ratio (r=0.328, p=0.01), and LVEDV (r=0.278, p=0.04). hs-TnI was not correlated with TAPSE and LAVI (r=0.241; p=0.07 and r=-0.13; p=0.429, respectively). The correlation between hs-troponin I with LVEF, E/A ratio and LVEDV proved that the degree of myocardial injury is directly associated with left ventricle (LV) systolic and diastolic dysfunction and also with LV dilatation. While it is not correlated with right ventricle (RV) systolic function. HsTnI may represent the injury in LV better than RV. Conclusion: These findings support the association of hs-TnI as a circulating marker of cardiomyocyte injury with LV dysfunction (systolic and diastolic) and dilatation in chronic HFrEF patients. This has expanded the role of hs-TnI in chronic heart disease.