Berg DD, Docherty KF, Sattar N, et al. - In patients with heart failure (HF) with reduced ejection fraction, worse clinical outcomes were observed in relation to higher baseline high-sensitivity cardiac troponin T (hsTnT) and greater increase in hsTnT over 1 year. The risk of the primary endpoint (adjudicated worsening HF or cardiovascular death) was decreased consistently by dapagliflozin, regardless of baseline hsTnT levels.

• In a randomized, double-blind, placebo-controlled trial (DAPA-HF) of dapagliflozin (10 mg daily) in patients with NYHA class II-IV symptoms and left ventricular ejection fraction ≤40% (median follow-up = 18.2 months), hsTnT was recorded at baseline in 3,112 patients as well as at 1 year in 2,506 patients.

• A ≥10% relative rise or decline in hsTnT levels in 67.9% of patients, and a ≥20% relative change in 43.5%, was evident over 1 year.

• For the primary endpoint, a stepwise gradient of higher risk was noted across increasing quartiles of baseline hsTnT level (adjusted hazard ratio Q4 vs Q1, 5.10).

• Higher subsequent risk of the primary endpoint was observed in relation to relative and absolute increases in hsTnT over 1 year.

• Dapagliflozin-induced relative reduction in the primary endpoint was found to be consistent across quartiles of baseline hsTnT but the greatest absolute risk reduction was seen in patients in the top quartile (absolute risk difference, 7.5%).

• Dapagliflozin vs placebo attenuated the increment in hsTnT over time (relative least squares mean reduction, −3% [-6% to 0%]).