Circulating Cardiac Troponin I Levels Measured by a Novel Highly Sensitive Assay in Acute Decompensated Heart Failure: Insights From the ASCEND-HF Trial

Grodin, Justin L.; Butler, Javed; Metra, Marco; Felker, G. Michael; Voors, Adriaan A.; McMurray, John J.V.; Armstrong, Paul W.; Hernandez, Adrian F.; O’Connor, Christopher M.; Starling, Randall C.; Tang, W.H. Wilson

doi:10.1016/j.cardfail.2018.06.008

Cited by 9 publications

(6 citation statements)

References 34 publications

(45 reference statements)

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“…Unlike prior HF clinical trials, where myocardial injury with higher sensitivity assays above the MI threshold exceeds 90%, 18,26 the proportion of patients with myocardial injury was much lower in our cohort; 66% to 77% depending on the threshold. Despite a smaller proportion of myocardial injury patients, 30-day outcomes were similar.…”

Section: Discussioncontrasting

confidence: 67%

“…19,27 The preponderance of evidence supports troponin as an adverse prognostic marker; however, not all studies have found troponin to be a risk factor for mortality. 26,28 In the era of newer, more highly sensitive assays, how to best interpret an elevated troponin is also not well known. While we utilized the value the 4 th Universal Definition of Myocardial Infarction 29 as the diagnostic threshold for myocardial injury in the setting of suspected ACS, these are unlikely to be the ideal cut-points for risk in AHF.…”

Section: Discussionmentioning

confidence: 99%

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TACIT (High Sensitivity Troponin T Rules Out Acute Cardiac Insufficiency Trial)

Pang

Fermann

Hunter

et al. 2019

Circ: Heart Failure

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Background-Identifying low-risk acute heart failure (AHF) patients safe for discharge from the emergency department (ED) is a major unmet need. Methods-A prospective, observational, multi-center pilot study targeting lower risk AHF patients to determine whether high sensitivity troponin T (hsTnT) identifies ED AHF patients at low risk for re-hospitalization and mortality. hsTnT was drawn at baseline and 3 hours. Phone follow up occurred at 30 and 90 days. The primary endpoint: composite of all-cause mortality, rehospitalization, and ED visits at 90 days (changed from 30 days due to lack of mortality events), analyzed using logistic regression. Secondary endpoints: 30 and 90-day all-cause mortality. hsTnT values less than the 99 th %ile were defined as 'low' hsTnT. Results-Out of 527 enrolled patients, 499 comprised the initial analysis set. Of these, 332 had both 0 and 3-hour hsTnT drawn, of whom 319 completed 30 day follow up. The average age was 62, 60% male, and 57% Black. Median hsTnT was 26.4ng/L (IQR 15.1-44.3). There were 99 (21%) 30-day composite events, 13 (2.7%) deaths at 30 days and 25 deaths (8.2%) at 90 days. Serial hsTnT values below the 99 th %ile were not associated with a lower risk for the 90-day primary composite endpoint (OR 0.79 (95% CI 0.42-1.50) p=0.4736). However, no deaths occurred in the low hsTnT group at 30 days with 1 death at 90 days. Conclusions-hsTnT did not identify patients at low risk for the primary outcome of rehospitalization, ED visits, and mortality at 90 days.

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Section: Discussioncontrasting

confidence: 67%

Section: Discussionmentioning

confidence: 99%

TACIT (High Sensitivity Troponin T Rules Out Acute Cardiac Insufficiency Trial)

Pang

Fermann

Hunter

et al. 2019

Circ: Heart Failure

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“…This is consistent with previous studies showing that cTnI was induced in patients with FM and those with AMI‐induced acute HF, compared with patients with other causes induced by hemodynamically unstable acute HF. 35 , 36 Therefore, the plasma sST2 induction observed in patients with FM may not only be caused by a generic systemic inflammatory response but also by local cardiac stress. From longitudinal examination, we further demonstrated that the induction of plasma sST2 was observed at the onset of FM, then dynamically normalized along with the resolution of the disease during hospitalization and remained stable during post‐FM period.…”

Section: Discussionmentioning

confidence: 99%

Soluble ST2 Is a Sensitive and Specific Biomarker for Fulminant Myocarditis

Wang

et al. 2022

JAHA

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Background The aim of the study was to identify biomarkers that can facilitate early diagnosis and treatment of fulminant myocarditis (FM) in order to reduce mortality. Methods and Results First, the expression profiles of circulating cytokines were determined in the plasma samples from 4 patients with FM and 4 controls using human cytokine arrays. The results showed that 39 cytokines from patients with FM were changed at admission. Among them, 8 cytokines returned to normal levels at discharge, including soluble ST2 (sST2), which showed the most marked dynamic changes from disease onset to resolution. Then, in a cohort of 76 patients with FM, 57 patients with acute hemodynamic dysfunction attributable to other causes, and 56 patients with non‐FM, receiver operating characteristic curve analyses suggested that plasma sST2 level was able to differentiate FM from non‐FM or other FM‐unrelated acute heart failure more robustly N‐terminal pro‐B‐type natriuretic peptide or cardiac troponin I. Moreover, longitudinal analysis of plasma sST2 was performed in 10 patients with FM during hospitalization and 16 patients with FM during follow‐up. Finally, the diagnostic value was validated in an additional 26 patients with acute onset of unstable hemodynamics. The cutoff value of plasma sST2 for optimal diagnosis of FM was established at 58.39 ng/mL, where a sensitivity of 85.7% and specificity of 94.7% were achieved. Conclusions Elevated sST2 level was associated with mechanical stress or inflammation. Especially, sST2 might be used as a potential biomarker for the rapid diagnosis of FM, which was characterized by strong mechanical stretch stimulation and severe inflammatory response. Registration URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03268642.

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“… 33 In a multi‐marker strategy, patients with all three biomarkers below their optimal cutoff point (based upon the receiver operating characteristic curves) had the best survival (0% death) at a median follow‐up of 739 days, while 53% of those with elevation of all three biomarkers died. Concentrations of cardiac troponin may also be useful to predict in‐hospital 20 , 34 and post‐discharge outcomes following hospital‐based treatment for acute HF. 35 , 36 For example, in one cohort of 1074 patients with acute HF undergoing serial measurement of hs‐cTnT, higher baseline or peak hs‐cTnT and greater peak change predicted adverse outcome, particularly strongest for 180‐day cardiovascular mortality (HR per doubling of baseline hs‐cTnT 1.36; 95% CI 1.15–1.60).…”

Section: Cardiac Specificmentioning

confidence: 99%

Circulating heart failure biomarkers beyond natriuretic peptides: review from the Biomarker Study Group of the Heart Failure Association (HFA), European Society of Cardiology (ESC)

Meijers

Bayés‐Genís

Mebazaa

et al. 2021

European J of Heart Fail

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New biomarkers are being evaluated for their ability to advance the management of patients with heart failure. Despite a large pool of interesting candidate biomarkers, besides natriuretic peptides virtually none have succeeded in being applied into the clinical setting. In this review, we examine the most promising emerging candidates for clinical assessment and management of patients with heart failure. We discuss high-sensitivity cardiac troponins (Tn), procalcitonin, novel kidney markers, soluble suppression of tumorigenicity 2 (sST2), galectin-3, growth differentiation factor-15 (GDF-15), cluster of differentiation 146 (CD146), neprilysin, adrenomedullin (ADM), and also discuss proteomics and genetic-based risk scores. We focused on guidance and assistance with daily clinical care decision-making. For each biomarker, analytical considerations are discussed, as well as performance regarding diagnosis and prognosis. Furthermore, we discuss potential implementation in clinical algorithms and in ongoing clinical trials.

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Circulating Cardiac Troponin I Levels Measured by a Novel Highly Sensitive Assay in Acute Decompensated Heart Failure: Insights From the ASCEND-HF Trial

Abstract: 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.

Cited by 9 publications

References 34 publications

TACIT (High Sensitivity Troponin T Rules Out Acute Cardiac Insufficiency Trial)

TACIT (High Sensitivity Troponin T Rules Out Acute Cardiac Insufficiency Trial)

Soluble ST2 Is a Sensitive and Specific Biomarker for Fulminant Myocarditis

Circulating heart failure biomarkers beyond natriuretic peptides: review from the Biomarker Study Group of the Heart Failure Association (HFA), European Society of Cardiology (ESC)

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