Prognostic value of high sensitivity troponin T in patients with acutely decompensated heart failure and non-detectable conventional troponin T levels

Parissis, John; Papadakis, John E.; Kadoglou, Nikolaos P.E.; Varounis, Christos; Psarogiannakopoulos, Panagiotis; Rafouli‐Stergiou, Pinelopi; Ikonomidis, Ignatios; Paraskevaidis, Ioannis; Dimopoulou, Ioanna; Zerva, Aikaterini; Dima, Kleante; Anastasiou-Nana, Maria; Filippatos, Gerasimos

doi:10.1016/j.ijcard.2013.05.056

Cited by 37 publications

(21 citation statements)

References 27 publications

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“…In another study, 113 patients with AHF and a conventional cTnT test result below the cutoff of 0.03 ng/ml on admission were enrolled. 38 An elevated admission hsTnT level, especially if >77 pg/ml, was found to be a significant predictor of death, and retained this significance in multivariate analysis with HR of 1.003. In a retrospective analysis of 100 patients admitted with AHF and hsTnT values measured on days 1 and 3, patients in whom the hsTnT levels decreased were found to respond to therapy and return to a compensated state, while those whose hsTnT levels did not change remained decompensated.…”

Section: Prognostic Value Of Hstnmentioning

confidence: 87%

Role of Cardiac Troponin Levels in Acute Heart Failure

Wettersten

Maisel

2015

Cardiac Failure Review

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Cardiac troponin (cTn) is the primary biomarker for the diagnosis of myocardial necrosis in an acute coronary syndrome (ACS). cTn levels can also be elevated in many other conditions, including heart failure, with significant prognostic value. An elevated cTn level can be found in both acute and chronic heart failure and its presence is believed to be due to multiple different pathophysiological processes. In acute decompensated heart failure (AHF), an elevated cTn level has been repeatedly shown to correlate with increased short- and long-term mortality and, to a lesser extent, readmission rates. These associations have been demonstrated with both I and T isoforms of cTn, as well as when troponin is measured with conventional assays or new high-sense assays. In multimarker models, cTn has repeatedly been found to be an independent predictive variable enhancing prognostic ability of the model. cTn is therefore an important biomarker for prognosis in AHF.

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Section: Prognostic Value Of Hstnmentioning

confidence: 87%

Role of Cardiac Troponin Levels in Acute Heart Failure

Wettersten

Maisel

2015

Cardiac Failure Review

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“…The percentages of patients who had detectable or elevated cTn varied widely across the studies (6.2%-68%). Most studies Del Carlo et al 31 2009 * * * * * 5 Felker et al 6 2012 * * * * * 5 Gattis et al 7 2004 * * * * * * * 7 Guisado Espartero et al 32 2014 * * * * * * 6 Ishii et al 21 2002 * * * * * 5 Kuwabara et al 22 2007 * * * * * 5 La Vecchia et al 23 2000 * * * * * * * 7 La Corvoisie et al 17 2014 * * * * * * * 7 Manzano-Fernandez et al 33 2009 * * * * * 5 Metra et al 24 2007 * * * * * 5 Nakamura et al 36 2014 * * * * * * * * 8 O'Connor et al 8 2011 * * * * * * * * 8 Oliveira et al 34 2010 * * * * * * * * 8 Parissis et al 20 2011 * * * * * * * 7 Parissis et al 25 2013 * * * * * * * * 8 Pascual-Figal et al 37 2012 * * * * * * 6 Peacock et al 15 2008 * * * * * * * * * 9 Perna et al 18 2005 * * * * * * * 7 Perna et al 19 2002 * * * * * * 6 Perna et al 26 2012 * * * * * * 6 Rudiger et al 27 2005 * * * * * * 6 Shah et al 16 2007 * * * * 4 Wallenborn et al 28 2013 * * * * * * * 7 Xue et al 29 2011 * * * * * * * 7 You et al 35 2007 * * * * * * * * * 9 Zairis et al 30 2010 * * * * * * * 7…”

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

“…Short-term (0 to 6 Months) Clinical Outcomes Short-term clinical outcome was assessed in 13 studies. 6,8,16,[21][22][23][24][25][26][27][28][29][30] Nine studies addressed mortality, 6,16,[23][24][25][26][27][28]30 2 studies readmission, 16,26 and 7 studies a composite of readmission and mortality during 6 months postdischarge. 6,8,21,22,24,26,29 The meta-analysis showed increased mortality without significant heterogeneity (OR: 2.11, 95% CI: 1.43-3.12, P 5 0.000, I 2 8.5%, 9 studies, n 5 3471) and an increase in the composite of readmission and mortality with significant heterogeneity (OR: 2.81, 95%CI: 1.60-4.92, P 5 0.000, I 2 89.1%, 7 studies, n 5 2028) among ADHF patients with detectable or elevated cTn.…”

Section: In-hospital Clinical Outcomesmentioning

confidence: 99%

Cardiac troponin in patients hospitalized with acute decompensated heart failure: A systematic review and meta‐analysis

Yousufuddin

Abdalrhim

Wang

et al. 2016

Journal of Hospital Medicine

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BACKGROUND Elevated cardiac troponin (cTn) is often observed in patients with acute decompensated heart failure (ADHF). We assessed the magnitude of association and quality of supporting evidence between cTn and clinically important outcomes in persons hospitalized for ADHF. METHODS We searched MEDLINE In‐Process & Other Non‐Indexed Citations, MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Scopus from inception through February 28, 2015. The outcomes analyzed included hospital length of stay (LOS), readmissions, and mortality. Random effects meta‐analysis was used to combine outcomes across studies. RESULTS We included 26 clinical studies. A detectable or elevated cTn was associated with increased LOS (odds ratio [OR]: 1.05; 95% confidence interval [CI]: 1.01‐1.10), increased in‐hospital mortality (OR: 2.57; 95% CI: 2.27‐2.91), and a composite of mortality and major adverse events (OR: 1.33; 95% CI: 1.03‐1.71) during hospitalization. ADHF patients with a detectable or elevated cTn were at increased risk for mortality and composite of mortality and readmission over the short term (mortality OR: 2.11; 95% CI: 1.43‐3.12; composite OR: 2.81; 95% CI: 1.60‐4.92), intermediate term (mortality OR: 2.21; 95% CI: 1.46‐3.35; composite OR: 2.30; 95% CI: 1.78‐2.99), and long term (mortality OR: 3.69; 95% CI: 2.64‐5.18; composite OR: 3.49; 95% CI: 2.08‐5.84). The overall confidence in estimates was moderate. CONCLUSIONS Among ADHF patients, a detectable or elevated cTn identifies subjects at increased risk for adverse clinical outcomes during acute hospitalization and those at higher risk for postdischarge mortality and composite of readmission and mortality. Journal of Hospital Medicine 2016;11:446–454. 2016 Society of Hospital Medicine

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“…In another prospective study of 113 patients with no detectable conventional TnT but with elevations of hsTnT, hsTnT was significantly related to death (HR: 1.002 with 95%: CI: 1.001-1.003; p = 0.001). In multivariate analysis, hsTnT remained a significant predictor of death after adjustment for age, gender, ejection fraction and creatinine levels (HR: 1.003; 95% CI: 1.001-1.005; p = 0.008) [87].…”

Section: Natriuretic Peptide Testing In Other Settingsmentioning

confidence: 97%

The potential role of natriuretic peptides and other biomarkers in heart failure diagnosis, prognosis and management

Ibrahim

Januzzi²

2015

Expert Review of Cardiovascular Therapy

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Heart failure (HF) is a complex disease process that is challenging to diagnose and manage. For more than 15 years, biomarkers have been used to diagnose and the guide the management of patients with this disease. The gold standard biomarkers for HF are B-type natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP); both are used for diagnosis and prognosis. More recently, there has been an interest in use of BNP and NT-proBNP for HF management as well. Important aspects regarding production and clearance of BNP and NT-proBNP exist, which are vital for the clinician to understand. Beyond BNP or NT-proBNP, other newer biomarkers such as mid-regional pro-atrial natriuretic peptide, soluble ST2, highly sensitive troponin and renal biomarkers may add value for prognostication and possibly, patient management. In this article, the authors will discuss the established and evolving role of BNP and NT-proBNP in HF, along with consideration of select newer biomarkers in this setting.

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Prognostic value of high sensitivity troponin T in patients with acutely decompensated heart failure and non-detectable conventional troponin T levels

Cited by 37 publications

References 27 publications

Role of Cardiac Troponin Levels in Acute Heart Failure

Role of Cardiac Troponin Levels in Acute Heart Failure

Cardiac troponin in patients hospitalized with acute decompensated heart failure: A systematic review and meta‐analysis

The potential role of natriuretic peptides and other biomarkers in heart failure diagnosis, prognosis and management

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