Untangling the relationship between hemoglobin, peak troponin level, and mortality in patients with myocardial
Vojko Kanic1, Gregor Kompara1, David Suran1
1Department of Cardiology and Angiology, Division of Internal Medicine, University Medical Center Maribor, Maribor, Slovenia.
Insights
Patients with lower admission hemoglobin (aHb) levels experience greater myocardial injury relative to heart size. Indexing troponin to body surface area (BSA) provides comparable cardiac injury information and may explain worse outcomes in low aHb patients.
Area of Science:
- Cardiology
- Biochemistry
- Clinical Medicine
Background:
- Patients with myocardial infarction (MI) and lower admission hemoglobin (aHb) levels exhibit poorer outcomes.
- Hemoglobin levels correlate positively with body surface area (BSA) and cardiac mass.
- This suggests lower aHb may indicate proportionally greater myocardial injury.
Purpose of the Study:
- To investigate the relationship between admission hemoglobin (aHb) and troponin (Tn) normalized to body surface area (BSA) (Tn/BSA).
- To assess the association between Tn/BSA and 30-day mortality in myocardial infarction (MI) patients.
- To determine if indexing troponin to BSA offers a more comparable measure of cardiac injury relative to cardiac mass.
Main Methods:
- Analysis of data from 6055 patients with myocardial infarction (MI).
- Patients were stratified into seven groups based on admission hemoglobin (aHb) levels.
- Statistical analysis assessed relationships between aHb, Tn/BSA, and 30-day mortality.
Main Results:
- Higher aHb levels were associated with greater BSA.
- A significant negative correlation was found between aHb and log10Tn/BSA across the entire cohort and in both sexes.
- log10Tn/BSA was significantly associated with 30-day mortality in the overall group and separately in men and women.
Conclusions:
- Similar peak troponin (Tn) values in patients with lower admission hemoglobin (aHb) indicate comparatively greater myocardial injury relative to cardiac mass.
- This finding helps explain the worse outcomes observed in patients with lower aHb.
- Indexing troponin to BSA is recommended for a more comparable assessment of cardiac injury relative to cardiac mass.
Abstract:
Patients with a history of myocardial infarction (MI) and lower admission hemoglobin (aHb) levels have a worse outcome than patients with higher aHb, but lower or similar peaks in enzymatic infarct size. Hemoglobin levels are positively correlated with body surface area (BSA), which is positively correlated with cardiac mass. We hypothesized that patients with lower aHb suffer comparatively greater myocardial injury. We examined the relationships between aHb, and troponin (Tn) normalized to BSA (Tn/BSA) and its association with 30-day mortality. Data from 6055 patients, who were divided into seven groups based on their aHb at 10g/L intervals, were analyzed, and the groups were compared. The relationships between aHb and Tn/BSA and between Tn/BSA and 30-day mortality were assessed. Patients with higher aHb levels had greater BSA (p<0.0001). A negative relationship between aHb and log10Tn/BSA was observed in the entire group, and in men and women separately (p<0.0001, p<0.0001, and p=0.013, respectively). The log10Tn/BSA value was associated with 30-day mortality in the entire group, and in men and women separately (p<0.0001, p=0.014, and p<0.0001, respectively). Our finding suggests that a similar peak Tn value in patients with lower aHb means comparatively greater myocardial injury relative to cardiac mass. This hypothesis helps to explain the worse outcomes in patients with lower aHb. According to our findings, troponin should be indexed to BSA to provide comparable information on cardiac injury relative to cardiac mass. Whether this relationship is causal remains to be clarified.
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