Serial changes in high-sensitive troponin I predict outcome in patients with decompensated heart failure
Yang Xue1, Paul Clopton, William F Peacock
1Department of Medicine, University of California at San Diego, 200 West Arbor Drive, San Diego, CA 92103, USA. yxue100@yahoo.com
Insights
Small elevations in troponin I (TnI) and brain natriuretic peptide (BNP) predict higher mortality and readmission in heart failure (HF) patients. TnI is a strong prognostic marker, with rising levels during hospitalization indicating increased mortality risk.
Area of Science:
- Cardiology
- Biomarker Research
- Heart Failure Management
Background:
- Decompensated heart failure (HF) presents a significant clinical challenge with high rates of mortality and readmission.
- Prognostic markers are crucial for risk stratification and guiding treatment decisions in acute HF.
- The utility of cardiac biomarkers like troponin I (TnI) and brain natriuretic peptide (BNP) in predicting outcomes in HF requires further elucidation.
Purpose of the Study:
- To assess the prognostic value of minor troponin I (TnI) elevations in patients with acute decompensated heart failure.
- To evaluate the predictive capability of serial TnI measurements for mortality and readmission.
- To compare the prognostic performance of TnI, BNP, and their combination in acute HF.
Main Methods:
- A cohort of 144 patients with acute HF was followed for 90 days post-discharge.
- Troponin I (TnI) and brain natriuretic peptide (BNP) levels were measured serially during hospitalization.
- Receiver operating characteristic (ROC) analysis determined optimal cut-off values for discharge TnI (23.25 ng/L) and BNP (360 ng/L).
Main Results:
- Discharge TnI levels above 23.25 ng/L were significantly associated with increased 90-day mortality and readmission (P = 0.003).
- Higher TnI quartiles and combined elevated TnI and BNP levels correlated with poorer outcomes.
- Increasing TnI levels during hospitalization independently predicted increased mortality (P = 0.009), outperforming BNP in multivariate analysis.
Conclusions:
- Even small elevations in TnI and BNP are significant predictors of 90-day mortality and readmission in acute HF.
- TnI demonstrates comparable or superior prognostic accuracy to BNP for predicting adverse outcomes in HF.
- Monitoring TnI trends during hospitalization is vital for identifying high-risk HF patients.
Aims:
The aim of this study was to evaluate the prognostic utility of small troponin I (TnI) elevations, serial TnI measurements, and the combination of TnI and brain natriuretic peptide (BNP) in patients with decompensated heart failure (HF).
Methods And Results:
One hundred and forty-four patients with acute HF were followed from admission to 90 days post-discharge. Primary endpoints were all cause mortality and HF-related readmission. Troponin I and BNP levels were checked on admission, discharge, and up to four consecutive days during hospitalization. A discharge TnI cut-off of 23.25 ng/L and discharge BNP cut-off of 360 ng/L were determined by receiver operator characteristic (ROC). Troponin I above 23.25 ng/L is associated with increased risk for mortality and readmission (P = 0.003). Comparing with TnI quartile 1, TnI quartiles 2-4 had increased mortality and readmission, P = 0.019, P = 0.007, P = 0.014, respectively. Compared with patients with low TnI+low BNP, increased mortality and readmission were seen in patients with high TnI+high BNP (P = 0.007), high TnI+low BNP (P = 0.015), and low TnI+high BNP (P = 0.042). Patients with increasing TnI during treatment had increased mortality compared with patients with stable or decreasing TnI (P = 0.047). In multivariate analysis, TnI reached statistical significance (P = 0.009), while BNP did not.
Conclusion:
This study demonstrates that very small TnI elevations and BNP elevations are associated with increased 90-day mortality and readmission. When compared by ROC and multivariate analysis, TnI is as good a predictor of mortality and readmission as BNP if not slightly better. Patients with increasing TnI during hospitalization for acute HF had increased risk for 90-day mortality.
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