Elevated troponin I level assessed by a new high-sensitive assay and the risk of poor outcomes in patients with acute heart failure

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• 作者：R. Zymliński^a ; ^{robertzymlinski@gmail.com} ; M. Sokolski^a ; ^b ; P. Siwolowski^a ; J Biegus^a ; ^b ; S. Nawrocka^a ; E.A. Jankowska^a ; ^b ; J. Todd^c ; R. Yerramilli^c ; J. Estis^c ; W. Banasiak^a ; P. Ponikowski^a ; ^b
• 关键词：Acute heart failure ; High-sensitivity cardiac troponin
• 刊名：International Journal of Cardiology
• 出版年：2017
• 出版时间：1 March 2017
• 年：2017
• 卷：230
• 期：Complete
• 页码：646-652
• 全文大小：376 K
• 卷排序：230

文摘

The interpretation and clinical usefulness of elevated levels of cardiac troponins in acute heart failure (AHF) remain controversial. We aimed to characterize the relationship between changes in cardiac troponin I (measured using a new high-sensitive immunoassay by single-molecule counting technology, Singulex, Alameda, USA; hs-TnI) during first 48 h of hospital stay and patients' characteristics and the outcomes.Methods and resultsWe measured hs-TnI at baseline, after 24 and 48 h in 130 AHF patients (mean age: 65 ± 13 years, 77% men). The percentage of patients with elevated hs-TnI (i.e., above the upper reference limit [URL] > 10.19 pg/mL) were: on admission – 59%, after 24 h – 61%, and after 48 h – 58%. Elevated baseline level of hs-TnI was associated with more severe dyspnoea on admission but neither peak level nor changes in hs-TnI during first 48 h were related to the dyspnoea severity or magnitude of dyspnoea relief. During 1-year follow-up there were 32 (25%) cardiovascular deaths. Neither absolute baseline nor peak values of hs-TnI predicted cardiovascular mortality. Only changes in hs-TnI were independently associated with cardiovascular mortality with the strongest relationship seen in peak change in hs-TnI: patients with an increase vs. remaining patients - hazard ratio (95% confidence interval): 3.22 (1.52–6.82)p = 0.002.ConclusionsUsing the new assay (proved to be more sensitive that the other available troponin assays) we observed that approximately 60% of patients with AHF presented elevated hs-TnI above URL during first 48 h of hospital stay. Only significant increase in hs-TnI predicted cardiovascular mortality.