Troponin I in acute decompensated heart failure: insights from the ASCEND-HF study.

Abstract

AIMS:

We examined the prognostic importance of cardiac troponin I (cTnI) in a cohort of patients enrolled in the ASCEND-HF study of nesiritide in acute decompensated heart failure (ADHF). Circulating troponins are a prognostic marker in patients with ADHF. Contemporary assays with greater sensitivity require reassessment of the significance of troponin elevation in HF.

METHODS AND RESULTS:

Cardiac troponin I was measured in a core laboratory in 808 ADHF patients enrolled in the ASCEND-HF biomarkers substudy using a sensitive assay (VITROS Trop I ES, Ortho Clinical Diagnostics) with a lower limit of detection of 0.012 ng/mL and a 99th percentile upper reference limit (URL) of 0.034 ng/mL. Patients with clinical evidence of acute coronary syndrome or troponin >5× the URL were excluded. Multivariable modelling was used to assess the relationship between log(cTnI) and in-hospital and post-discharge outcomes. Baseline cTnI was undetectable in 22% and elevated above the 99th percentile URL in 50% of subjects. cTnI levels did not differ based on HF aetiology. After multivariable adjustment, higher cTnI was associated with worsened in-hospital outcomes such as length of stay (P = 0.01) and worsening HF during the index hospitalization (P = 0.01), but was not associated with worsened post-discharge outcomes at 30 or 180 days. The relationship between cTnI and outcomes was generally linear and there was no evidence of a threshold effect at any particular level of cTnI.

CONCLUSION:

cTnI is elevated above the 99th percentile URL in 50% of ADHF patients and predicts in-hospital outcome, but is not an independent predictor of long-term outcomes.

• Authors: G Michael Felker, Vic Hasselblad, W H Wilson Tang, Adrian F Hernandez, Paul W Armstrong, Gregg C Fonarow, Adriaan A Voors, Marco Metra, John J V McMurray, Javed Butler, Gretchen M Heizer, Kenneth Dickstein, Barry M Massie, Dan Atar, Richard W Troughton, Stefan D Anker, Robert M Califf, Randall C Starling, Christopher M O'Connor
• Journal: European journal of heart failure (Eur J Heart Fail) Vol. 14 Issue 11 Pg. 1257-64 (Nov 2012) ISSN: 1879-0844 [Electronic] England
• PMID: 22764184 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Natriuretic Agents
• Troponin I
• Natriuretic Peptide, Brain

Topics

• Aged
• Confidence Intervals
• Female
• Heart Diseases (blood, mortality, pathology)
• Humans
• Male
• Models, Statistical
• Multivariate Analysis
• Natriuretic Agents (blood)
• Natriuretic Peptide, Brain (blood)
• Odds Ratio
• Prognosis
• Statistics as Topic
• Troponin I (blood)