Circulating cardiac troponin I levels measured by a novel highly sensitive assay in acute decompensated heart failure: insights from the ASCEND-HF trial

Grodin, J. L. et al. (2018) Circulating cardiac troponin I levels measured by a novel highly sensitive assay in acute decompensated heart failure: insights from the ASCEND-HF trial. Journal of Cardiac Failure, 24(8), pp. 512-519. (doi:10.1016/j.cardfail.2018.06.008) (PMID:30012361)

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Publisher's URL: https://www.onlinejcf.com/article/S1071-9164(18)30261-6/abstract

Abstract

Background: Circulating cardiac troponin levels (cTn), representative of myocardial injury, are commonly elevated in heart failure (HF) and related to adverse clinical events. However, whether cTn represents a spectrum of risk in HF is unclear. Methods: Baseline, 48–72 hour, and 30 day plasma cTnI was measured by a novel highly-sensitive assay in 900 subjects with acute decompensated HF (ADHF) in ASCEND-HF. Multivariable models determined the relationship between cTnI and outcomes. Results: The median(interquartile range) cTnI was 16.4 (9.3-31.6) ng/L at baseline, 14.1 (7.8-29.7) ng/L at 48-72 hours, and 11.6 (6.8-22.5) ng/L at 30 days. After additional adjustment for amino terminal pro-B-type natriuretic peptide (NT-proBNP) to established risk predictors, both baseline and 48-72 hour cTnI were associated with higher risk for death or worsening HF prior to discharge (OR 1.25, P=0.03 and OR 1.43, P=0.001, respectively). However, only cTnI at 30 days was associated 180-day death (HR 1.25, P=0.007). There were no curvilinear associations between changing cTnI and clinical outcomes. Conclusions: Circulating cTnI level was associated with clinical outcomes in ADHF, but these observations diminished with additional adjustment for NT-proBNP. Although they likely represent a spectrum of risk in ADHF, these findings question the implications of changing cTnI levels during treatment.

Item Type:Articles
Additional Information:The ASCEND-HF study, including the biomarker substudy, was funded by Scios Inc.
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:McMurray, Professor John
Authors: Grodin, J. L., Butler, J., Metra, M., Felker, G. M., Voors, A. A., McMurray, J. J., Armstrong, P. W., Hernandez, A. F., O'Connor, C., Starling, R. C., and Tang, W.H. W.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
Journal Name:Journal of Cardiac Failure
Publisher:Elsevier
ISSN:1071-9164
ISSN (Online):1532-8414
Published Online:15 July 2018
Copyright Holders:Copyright © 2018 Elsevier Inc.
First Published:First published in Journal of Cardiac Failure 24(8): 512-519
Publisher Policy:Reproduced in accordance with the publisher copyright policy

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