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

Abstract

AimsWe 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 resultsCardiac 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 ¼ 0.01) and worsening HF during the index hospitalization (P ¼ 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.--

Role of Biomarkers for the Prevention, Assessment, and Management of Heart Failure: A Scientific Statement From the American Heart Association

“…155 In addition to the natriuretic peptides, there is a substantial literature on other biomarkers at the time of AHF hospitalization and subsequent risk. cTns have been shown in some studies, 175,177,185,186 but not others, 187 to predict postdischarge events. Some of these variations may be the result of differences in patient characteristics, troponin assay characteristics (which vary markedly 188 ), or possible publication bias.…”

“…25,236 Troponin changes during AHF therapy have been consistently observed, with most patients having gradual decreases in troponin levels over the course of hospitalization, although the clinical implications of these changes are less cle ar. 172,177,[185][186][187]234,237 Differences in the sensitivity of various assays have generally complicated interpretation of troponin values in the setting of AHF, although persistently elevated or rising troponin values seem to be associated with greater risk.…”

High-sensitivity troponin is associated with high risk clinical profile and outcome in acute heart failure

“…We believe that our study is the first one to demonstrate that subjects with coronary artery www.cardiologyjournal.org disease have greater hs-cTn levels than those with other etiologies. With the exception of the study published by Peacock et al [9], the other authors have not been able to demonstrate a statistically significant difference according to the etiology [10,11]. A possible explanation is that the patients with severe coronary stenoses may be more liable to the stress produced by an acute episode and, thus, have higher troponin levels.…”

Role of Cardiac Troponin Levels in Acute Heart Failure

“…In an analysis of the ASCEND-HF trial, an hsTnI level >0.034 ng/ml on admission was associated with an increased risk of in-hospital mortality, worsening heart failure during admission, and increased length of hospital stay in the first 7 days, but not long-term outcomes at 30 or 180 days. 36 A subset of patients had hsTnI measurements taken on admission and 48-72 hours later. Patients with a 20 % increase in hsTnI level had increased risk of 30-day mortality and in a logistic regression model the hsTnI value at 48-72 hours was associated with 30-day mortality, but not the value at admission.…”