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

Felker, G.M. et al. (2012) Troponin I in acute decompensated heart failure: insights from the ASCEND-HF study. European Journal of Heart Failure, 14(11), pp. 1257-1264. (doi:10.1093/eurjhf/hfs110)

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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.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:McMurray, Professor John
Authors: Felker, G.M., Hasselblad, V., Tang, W.H.W., Hernandez, A.F., Armstrong, P.W., Fonarow, G.C., Voors, A.A., Metra, M., McMurray, J.J.V., Butler, J., Heizer, G.M., Dickstein, K., Massie, B.M., Atar, D., Troughton, R.W., Anker, S.D., Califf, R.M., Starling, R.C., and O'Connor, C.M.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
Journal Name:European Journal of Heart Failure
ISSN:1388-9842
ISSN (Online):1879-0844
Published Online:04 July 2012

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