Circulating Cardiac Troponin I in Severe Congestive Heart Failure

Missov, Emile; Calzolari, Charles; Pau, Bernard

doi:10.1161/01.cir.96.9.2953

Cited by 350 publications

(213 citation statements)

References 25 publications

Supporting

Mentioning

184

Contrasting

Unclassified

Order By: Relevance

“…However, in chronic HF-especially with respect to its etiology-clinical value has not yet been clarified. 4,10,11 The progressive character of the disease is well known and most likely due to progressive myocardial cell damage. The process of ongoing minor myocardial injury may be associated with some form of cTnI release, which might be detectable by serial analysis of cTnI.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Serial analysis of troponin I levels in patients with ischemic and nonischemic dilated cardiomyopathy

Nellessen

Goder

Schobre

et al. 2006

Clinical Cardiology

View full text Add to dashboard Cite

SummaryBackground: Ongoing myocardial cell damage forms the basis for progression of chronic heart failure. Evidence is accumulating that progressive loss of cardiac myocytes is associated with the release of cardiac troponin I (cTnI).Hypothesis: This study sought to determine whether levels of cTnI are of prognostic value for risk stratification of patients with chronic heart failure.Methods: Release of cTnI was measured by conventional enzyme immunoassay following serum ultrafiltration in 58 consecutive patients hospitalized for chronic heart failure and 31 healthy volunteers serving as control group. Determination of serum levels was performed every 2 weeks over a time interval of 3 months. According to the results of coronary angiography, patients were divided into Group D showing normal coronary arteries (n = 33, ejection fraction 27 ± 6.1%) and Group I showing severe coronary heart disease (n = 25, ejection fraction 28.8 ± 7.8%). Survival of patients was evaluated after a mean time interval of 3 years.Results: The mean cTnI serum level over all measurements was 0.66 ± 1.8 ng/ml in patients versus 0.11 ± 0.48 ng/ml in volunteers. At all six points of analysis, the mean cTnI serum level was significantly different (p < 0.001) between patients and volunteers. There was no significant difference between patients with and without coronary heart disease following hospital discharge, however, troponin release was significantly different between survivors and nonsurvivors (n = 27) (0.56 ng/ml vs. 0.84 ng/ml; p < 0.05).

show abstract

Section: Discussionmentioning

confidence: 99%

“…10,12 Based on the data published so far, a clear statement about this phenomenon is not possible. In our opinion, cTnI release most likely reflects normal turnover of myocytes under physiologic conditions.…”

Section: Cardiac Troponin I Release In Healthy Volunteersmentioning

confidence: 99%

Serial analysis of troponin I levels in patients with ischemic and nonischemic dilated cardiomyopathy

Nellessen

Goder

Schobre

et al. 2006

Clinical Cardiology

View full text Add to dashboard Cite

show abstract

“…In the outpatient setting with CHF, the prevalence of myocardial injury was 25% to 50%. 14,16,17,21,22 Conversely, the presence of troponin in decompensated CHF was also associated with more profound clinical and hemodynamic deterioration, more severe LV remodeling, and worse short-and long-term prognosis. 15,[23][24][25][26][27] Combining cTnT and brain natriuretic peptide (BNP) offers a new risk-stratifying tool that detects cellular injury as well as ventricular overload.…”

Section: Discussionmentioning

confidence: 99%

Ongoing Myocardial Injury in Stable Severe Heart Failure

Perna¹,

Macin²,

Canella³

et al. 2004

Circulation

124

View full text Add to dashboard Cite

Background-The progression of chronic heart failure (CHF) is related to ongoing myocyte loss, which can be detected by cardiac troponin T (cTnT). We examined the prevalence and prognostic value of increased cTnT concentrations in serial blood specimens from patients with severe CHF. Methods and Results-Clinical, echocardiographic, and 6-minute walk test data were collected prospectively at baseline and at 1 year in 115 outpatients (mean age, 61Ϯ11 years; 75% men; 62% coronary heart disease) with CHF and a left ventricular ejection fraction Ͻ40%. Blood samples were collected at baseline and at 3, 6, and 12 months of follow-up. cTnT concentrations Ն0.02 ng/mL were considered abnormal, and a Tn index (highest cTnT measurement/0.02 ng/mL) was calculated. In 62 patients (54%), cTnT was consistently Ͻ0.02 ng/mL (group 1); 28 (24%) had a single abnormal cTnT result (group 2); and 25 (22%) had Ն2 abnormal cTnT results (group 3). At 18 months, CHF hospitalization-free survival was 63%, 46%, and 17%, respectively (Pϭ0.0001). In a Cox proportional-hazards model, hospitalization for worsening CHF in the previous year (HRϭ2.1; 95% CI, 1.1 to 4.1), functional class III-IV (HRϭ2.3; 95% CI, 1.1 to 4.6), and number of abnormal cTnT samples (HRϭ1.6; 95% CI, 1.1 to 2.4) were independently associated with prognosis. A cTnT rise of 0.020 ng/mL in any sample was associated with an excess of 9% (95% CI, 1% to 18%) in the incidence of combined end point. Conclusions-Abnormal cTnT concentrations were detected in Ͼ50% of outpatients with advanced CHF. This ongoing myocardial necrosis was a strong predictor of worsening CHF, suggesting a role of cTnT-based monitoring to identify high-risk patients.

show abstract

“…Several small studies have reported elevated cardiac troponin levels in patients with decompensated HF, in the absence of acute coronary syndromes, and furthermore have correlated troponin elevation with poor prognosis. [2][3][4][5][6] Although the cardiac troponins, troponin I (cTnI) and troponin T, are well-established diagnostic and prognostic markers in acute coronary syndromes, 7,8 the role of troponins in the evaluation and risk stratification of patients with HF is less certain. Our study aimed to confirm and further explore the prognostic implications of cTnI levels in HF.…”

mentioning

confidence: 99%

Cardiac Troponin I Is Associated With Impaired Hemodynamics, Progressive Left Ventricular Dysfunction, and Increased Mortality Rates in Advanced Heart Failure

et al. 2003

View full text Add to dashboard Cite

Background-Cardiac troponin I (cTnI), a sensitive and specific marker of myocardial cell injury, is useful in diagnosing and assessing prognosis in acute coronary syndromes. Small studies report that cTnI is elevated in severe heart failure (HF) and may predict adverse outcomes. Methods and Results-The present study evaluated 238 patients with advanced HF referred for cardiac transplantation evaluation who had cTnI assay drawn at the time of initial presentation. Patients with acute myocardial infarction or myocarditis were excluded from analysis. cTnI was detectable (cTnI Ն0.04 ng/mL) in serum of 117 patients (49.1%).Patients with detectable cTnI levels had significantly higher B-type natriuretic peptide (BNP) levels (PϽ0.001) and more impaired hemodynamic profiles, including higher pulmonary wedge pressures (Pϭ0.002) and lower cardiac indexes (PϽ0.0001). A significant correlation was found between detectable cTnI and progressive decline in ejection fraction over time. Furthermore, detectable cTnI was associated with increased mortality risk (RR, 2.05; 95% CI, 1.22 to 3.43). After adjustment for other factors associated with adverse prognosis including age, sex, ejection fraction, and coronary artery disease, cTnI remained a significant predictor of death. cTnI used in conjunction with BNP further improved prognostic value. Conclusions-cTnI is associated with impaired hemodynamics, elevated BNP levels, and progressive left ventricular dysfunction in patients with HF. cTnI may be a novel, useful tool in identifying patients with HF who are at increased risk for progressive ventricular dysfunction and death.

show abstract

Circulating Cardiac Troponin I in Severe Congestive Heart Failure

Cited by 350 publications

References 25 publications

Serial analysis of troponin I levels in patients with ischemic and nonischemic dilated cardiomyopathy

Serial analysis of troponin I levels in patients with ischemic and nonischemic dilated cardiomyopathy

Ongoing Myocardial Injury in Stable Severe Heart Failure

Cardiac Troponin I Is Associated With Impaired Hemodynamics, Progressive Left Ventricular Dysfunction, and Increased Mortality Rates in Advanced Heart Failure

Contact Info

Product

Resources

About