Circulating Cardiac Troponin I Levels Measured by a Novel Highly Sensitive Assay in Acute Decompensated Heart
Justin L Grodin1, Javed Butler2, Marco Metra3
1Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.
Insights
Cardiac troponin (cTn) levels indicate myocardial injury in heart failure (HF). While cTnI levels correlate with adverse events in acute decompensated HF (ADHF), their predictive value diminishes when adjusted for NT-proBNP.
Area of Science:
- Cardiology
- Biomarkers
- Heart Failure Research
Background:
- Elevated circulating cardiac troponin (cTn) levels are common in heart failure (HF).
- cTn is associated with adverse clinical events in HF patients.
- The prognostic significance of cTn across the spectrum of HF risk remains unclear.
Purpose of the Study:
- To investigate the association between circulating cardiac troponin I (cTnI) levels and clinical outcomes in patients with acute decompensated heart failure (ADHF).
- To determine if cTnI represents a spectrum of risk in ADHF, independent of other established predictors.
- To evaluate the impact of adjusting for N-terminal pro-B-type natriuretic peptide (NT-proBNP) on the prognostic value of cTnI.
Main Methods:
- A highly sensitive assay was used to measure plasma cTnI at baseline, 48-72 hours, and 30 days in 900 ADHF patients from the ASCEND-HF study.
- Multivariable models were employed to assess the relationship between cTnI levels and clinical outcomes.
- Adjustments were made for established risk predictors, including NT-proBNP.
Main Results:
- Median cTnI levels showed a decreasing trend from baseline to 30 days.
- Both baseline and 48-72 hour cTnI levels were associated with increased risk of in-hospital death or worsening HF, even after adjustment for NT-proBNP.
- Only 30-day cTnI levels remained associated with 180-day mortality.
Conclusions:
- Circulating cTnI levels are associated with clinical outcomes in ADHF.
- The association between cTnI and outcomes is attenuated after adjustment for NT-proBNP.
- These findings raise questions about the clinical implications of changes in cTnI levels during ADHF treatment.
Background:
Circulating cardiac troponin levels (cTn), representative of myocardial injury, are commonly elevated in heart failure (HF) and related to adverse clinical events. However, whether cTn represents a spectrum of risk in HF is unclear.
Methods:
Baseline, 48-72-hour, and 30-day plasma cTnI was measured with the use of a new highly sensitive assay in 900 subjects with acute decompensated HF (ADHF) in ASCEND-HF. Multivariable models determined the relationship between cTnI and outcomes.
Results:
The median (interquartile range) cTnI was 16.4 (9.3-31.6) ng/L at baseline, 14.1 (7.8-29.7) ng/L at 48-72 hours, and 11.6 (6.8-22.5) ng/L at 30 days. After additional adjustment for N-terminal pro-B-type natriuretic peptide (NT-proBNP) to established risk predictors, both baseline (odds ratio [OR] 1.25; P = .03) and 48-72-hour (OR 1.43; P = .001) cTnI were associated with higher risk for death or worsening HF before discharge. However, only cTnI at 30 days was associated with 180-day death (hazard ratio 1.25; P = .007). There were no curvilinear associations between changing cTnI and clinical outcomes.
Conclusions:
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.
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