Abstract 11692: High-Sensitivity Cardiac Troponin and the Efficacy of Dapagliflozin in Patients With Heart Failure and Reduced Ejection Fraction: An Analysis of the DAPA-HF Trial
Bibliographic record
Abstract
Introduction: Circulating high-sensitivity cardiac troponin T (hsTnT) reflects myocardial injury, and higher levels are associated with an increased risk of worsening heart failure (HF) and death in patients with HF with reduced ejection fraction (HFrEF). Dapagliflozin reduces the rate of worsening HF or cardiovascular death in patients with HFrEF. The effect of dapagliflozin on the risk of worsening HF or CV death in relation to baseline concentration of hsTnT in patients with HFrEF is unknown. Methods: DAPA-HF was a randomized, double-blind, placebo-controlled trial of dapagliflozin (10 mg once daily) in patients with New York Heart Association class II, III, or IV HF and a left ventricular ejection fraction ≤40%. We measured hsTnT (Roche Diagnostics) at baseline in 3,138 patients randomized in DAPA-HF and at one year among 2,500 survivors. The primary outcome was adjudicated worsening HF or cardiovascular death. Secondary outcomes included each component individually, hospitalization for HF, and death from any cause. The median follow-up was 18.2 months. Results: By the time of this presentation, data will be available for presentation of the distribution of baseline hsTnT concentration and the clinical characteristics associated with strata of hsTnT concentration. The association between baseline hsTnT and 2-year outcomes will be presented and adjusted for potential confounders, including age, sex, eGFR, history of diabetes mellitus, and principal cause of HF (ischemic or non-ischemic). The effect of dapagliflozin on the change in hsTnT concentration from baseline to one year will be presented. The effect of dapagliflozin on the primary and secondary outcomes (both absolute and relative risk reductions) stratified by baseline hsTnT concentration will be analyzed. Conclusions: Biomarkers of myocardial injury identify patients with HFrEF at heightened risk of adverse outcomes. This analysis from a large, international, randomized, placebo-controlled trial will provide a robust assessment of the effect of dapagliflozin on hsTnT and the ability of dapagliflozin to improve outcomes in relation to baseline hsTnT concentration.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.004 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.003 | 0.003 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".