High-Sensitive Troponin I and Re-Hospitalization in Patients With Decompensated Congestive Heart Failure
-
Shokoufeh Hajsadeghi
,
Yaghoub Bagheri
,
Mohammad Hossein Ghafouri
,
Scott Reza Jafarian Kerman
,
Morteza Hassanzadeh
Abstract
Patients with heart failure (HF) are frequently admitted for episodes of decompensation. Cardiac troponins are easily accessible biomarkers role of which for risk stratification of re-hospitalization among HF patients is less certain. We aimed to evaluate high-sensitive cardiac troponin I (hs-cTnI) levels among re-hospitalized patients with decompensated heart failure (D-HF). Consecutive subjects admitted with D-HF to 2 hospitals in Tehran, during the year 2014 were recruited. Excluded ones were patients with a suspected acute coronary syndrome or myocarditis/pericarditis, those with cardiopulmonary resuscitation/DC shock delivery, or major complications during or after hospitalization. Along with echocardiography parameters, level of hs-cTnI was checked at the first hour of hospitalization and 3 months after discharge. The patients were then categorized according to having or not having re-hospitalization during 3 months post discharge. A total of 97 patients were finally recruited. Among re-hospitalized patients, Left ventricular (LV) ejection fraction was significantly lower (38±14 % vs. 50 ± 12%; P=0.001), and LV end-systolic dimension was significantly higher (44±9 mm vs. 38±11 mm; P=0.012) compared to the other group. Moreover, levels of hs-cTnI were significantly higher among the re-hospitalized patients, both at initial visit (0.66±0.43 ng/ml vs 0.51±0.14 ng/ml, respectively; P=0.017) and at 3 months (0.59±0.48 ng/ml vs 0.48±0.23 ng/ml, respectively; P=0.030). This prospective study demonstrated that levels of hs-cTnI (both at the base and at follow up) are higher among patients who readmitted during 3 months of hospitalization for D-HF.
1. Jessup M, Brozena S. Heart failure. N Engl J Med 2003;348:2007-18.
2. Cowie MR, Mosterd A, Wood DA, Deckers JW, Poole-Wilson PA, Sutton GC, et al. Clinical epidemiology of heart failure. Heart 2007;93:1137-46.
3. Ware LB, Matthay MA. Clinical practice. Acute pulmonary edema. N Eng J Med 2005;353:2788.
4. Peacock WF 4th, De Marco T, Fonarow GC, Diercks D, Wynne J, Apple FS, et al. Cardiac troponin and outcome in acute heart failure. N Engl J Med 2008;358:2117-26.
5. Goldberg RJ, Ciampa J, Lessard D, Meyer TE, Spencer FA. Long-term survival after heart failure: a contemporary population-based perspective. Arch Intern Med 2007;167:490-6.
6. Wang TJ. Significance of circulating troponins in heart failure: if these walls could talk. Circulation 2007;116:1217-20.
7. Horwich TB, Patel J, MacLellan WR, Fonarow GC. Cardiac troponin I is associated with impaired hemodynamics, progressive left ventricular dysfunction, and increased mortality rates in advanced heart failure. Circulation 2003;108:833-8.
8. Hudson MP, O'Connor CM, Gattis WA, Tasissa G, Hasselblad V, Holleman CM, et al. Implications of elevated cardiac troponin Tin ambulatory patientswith heart failure: a prospective analysis. Am Heart J 2004;147:546-52.
9. Perna ER, Macin SM, Canella JP, Augier N, Stival JL, Cialzeta JR, et al. Ongoing myocardial injury in stable severe heart failure: value of cardiac troponin T monitoring for high-risk patient identification. Circulation 2004;110:2376-82.
10. Miller WL, Hartman KA, Burritt MF, Grill DE, Rodeheffer RJ, Burnett JC Jr, et al. Serial biomarker measurements in ambulatory patients with chronic heart failure: the importance of change over time. Circulation 2007;116:249-57.
11. LaVecchia LL, Mezzena G, Zanolla L, Paccanaro M, Varotto L, Bonanno C, et al. Cardiac troponin I as a diagnostic and prognostic marker in severe heart failure. J Heart Lung Transplant 2000;19:644-52.
12. Sato Y, Yamada T, Taniguchi R, Nagai K, Makiyama T, Okada H, et al. Persistently increased serum concentrations of cardiac troponin T in patients with idiopathic dilated cardiomyopathy are predictive of adverse outcomes. Circulation 2001;103:369-74.
13. Missov M, Calzolari C, Pau B. Circulating cardiac troponin I in severe congestive heart failure. Circulation 1997;96:2953-8.
14. Setsuta K, Seino Y, Takahashi N, Ogawa T, Sasaki K, Harada A, et al. Clinical significance of elevated levels of cardiac troponin T in patients with chronic heart failure. Am J Cardiol 1999;84:608-11.
15. Del Carlo CH, O’Connor CM. Cardiac troponins in congestive heart failure. Am Heart J. 1999;138:646–653.
16. Ilva T, Lassus J, Siirilä-Waris K, Melin J, Peuhkurinen K, Pulkki K, et al. Clinical significance of cardiac troponins I and T in acute heart failure. Eur J Heart Fail 2008;10:772-79.
17. Apple FS, Murakami MM, Pearce LA, Herzog CA. Predictive value of cardiac troponin I and T for subsequent death in end-stage renal disease. Circulation 2002;106:2941-5.
18. Brunet P, Oddoze C, Paganelli F, Indreies M, Faure V, Opris-Saveanu A, et al. Cardiac troponins I and T in hemodialysis patients without acute coronary syndrome. Int J Cardiol 2008;129:205-9.
19. Sherwood MW, Kristin Newby L. High-sensitivity troponin assays: evidence, indications, and reasonable use. J Am Heart Assoc 2014;3:e000403
20. Nishio Y, Sato Y, Taniguchi R, Shizuta S, Doi T, Morimoto T, et al. Cardiac troponin T vs other biochemical markers in patients with congestive heart failure. Circ J 2007;71:631-5
21. Thavendiranathan P, Yingchoncharoen T, Grant A, Seicean S, Landers SH, Gorodeski EZ, et al. Prediction of 30-day heart failure-specific readmission risk by echocardiographic parameters. Am J Cardiol 2014;113:335-41
22. Proctor P, King DR, Fesel NM, Narveson SY, Anderson WE, Littmann L. Outcome of Patients Discharged From a Heart Failure Disease Management Program following Their Clinical and Echocardiographic Recovery. Cardiology 2015;131:197-202.
23. Demir M, Kanadasi M, Akpinar O, Do¨nmez Y, Avkarogullari M, Alhan C, et al. Cardiac troponin T as a
prognostic marker in patients with heart failure: a 3-year outcome study. Angiology 2007;58:603-9.
24. Perna ER, Macín SM, Parras JI, Pantich R, Farías EF, Badaracco JR, Jantus E, Medina F, Brizuela M. Cardiac troponin T levels are associated with poor short- and long-term prognosis in patients with acute cardiogenic pulmonary edema. Am Heart J 2002;143:814-20.
25. Gheorghiade M, Gattis Stough W, Adams JKF, Jaffe AS, Hasselblad V, O’Connor CM. The Pilot Randomized Study of Nesiritide Versus Dobutamine in Heart Failure (PRESERVD-HF). Am J Coll Cardiol 2005;96:18-25.
26. Guisado Espartero ME, Salamanca-Bautista P, Aramburu-Bodas O, Arias-Jimenez JL, Formiga F, Roca-Villanueva B, et al. Troponin T in acute heart failure: clinical implications and prognosis in the Spanish National Registry on Heart Failure. Eur J Intern Med 2014;25:739-44.
27. Metra M, Bettari L, Pagani F, Lazzarini V, Lombardi C, Carubelli V, et al. Troponin T levels in patients with acute heart failure: clinical and prognostic significance of their detection and release during hospitalisation. Clin Res Cardiol 2012;101:663-72.
28. Christopher M, O'Connor CM, Fiuzat M, Lombardi C, Fujita K, Jia G, et al. Impact of serial troponin release on outcomes in patients with acute heart failure: analysis from the PROTECT pilot study. Circ Heart Fail 2011;4:724-32.
29. Tsutamoto T, Kawahara C, Nishiyama K, Yamaji M, Fujii M, Yamamoto T, et al. Prognostic role of highly sensitive cardiac troponin I in patients with systolic heart failure. Am Heart J 2010;159:63-7.
30. Parenti N, Bartolacci S, Carle F, Angelo F. Cardiac troponin I as prognostic marker in heart failure patients discharged from emergency department. Intern Emerg Med 2008;3:43-7.
31. Xue Y, Clopton P, Peacock WF, Maisel AS. Serial changes in high-sensitive troponin I predict outcome in patients with decompensated heart failure. Eur J Heart Fail 2011;13:37-42.
32. Wu AH, Ford L. Release of cardiac troponin in acute coronary syndromes: ischemia or necrosis? Clin Chim Acta 1999;284:161-74.
33. Yiu KH, Lau KK, Zhao CT, Chan YH, Chen Y, Zhen Z, Wong A, Lau CP, Tse HF. Predictive value of high-sensitivity troponin-I for future adverse cardiovascular outcome in stable patients with type 2 diabetes mellitus. Cardiovasc Diabetol 2014;13:63.
34. Yiu KH, Zhao CT, Chen Y, Siu CW, Chan YH, Lau KK, et al. Association of subclinical myocardial injury with arterial stiffness in patients with type 2 diabetes mellitus. Cardiovasc Diabetol 2013;12:94.
35. Eggers KM, Nygren M, Venge P, Jernberg T, Wikström BG. High-sensitive troponin T and I are related to invasive hemodynamic data and mortality in patients with left-ventricular dysfunction and precapillary pulmonary hypertension. Clin Chem Acta 2011;412:1582-8.
36. Fox CS, Pencina MJ, Meigs JB, Vasan RS, Levitzky YS, D'Agostino RB Sr. Trends in the incidence of type 2 diabetes mellitus from the 1970s to the 1990s: the framingham heart study. Circulation 2006;113:2914-8.
37. Vasan RS. Biomarkers of cardiovascular disease: molecular basis and practical considerations. Circulation 2006;113:2335-62.
2. Cowie MR, Mosterd A, Wood DA, Deckers JW, Poole-Wilson PA, Sutton GC, et al. Clinical epidemiology of heart failure. Heart 2007;93:1137-46.
3. Ware LB, Matthay MA. Clinical practice. Acute pulmonary edema. N Eng J Med 2005;353:2788.
4. Peacock WF 4th, De Marco T, Fonarow GC, Diercks D, Wynne J, Apple FS, et al. Cardiac troponin and outcome in acute heart failure. N Engl J Med 2008;358:2117-26.
5. Goldberg RJ, Ciampa J, Lessard D, Meyer TE, Spencer FA. Long-term survival after heart failure: a contemporary population-based perspective. Arch Intern Med 2007;167:490-6.
6. Wang TJ. Significance of circulating troponins in heart failure: if these walls could talk. Circulation 2007;116:1217-20.
7. Horwich TB, Patel J, MacLellan WR, Fonarow GC. Cardiac troponin I is associated with impaired hemodynamics, progressive left ventricular dysfunction, and increased mortality rates in advanced heart failure. Circulation 2003;108:833-8.
8. Hudson MP, O'Connor CM, Gattis WA, Tasissa G, Hasselblad V, Holleman CM, et al. Implications of elevated cardiac troponin Tin ambulatory patientswith heart failure: a prospective analysis. Am Heart J 2004;147:546-52.
9. Perna ER, Macin SM, Canella JP, Augier N, Stival JL, Cialzeta JR, et al. Ongoing myocardial injury in stable severe heart failure: value of cardiac troponin T monitoring for high-risk patient identification. Circulation 2004;110:2376-82.
10. Miller WL, Hartman KA, Burritt MF, Grill DE, Rodeheffer RJ, Burnett JC Jr, et al. Serial biomarker measurements in ambulatory patients with chronic heart failure: the importance of change over time. Circulation 2007;116:249-57.
11. LaVecchia LL, Mezzena G, Zanolla L, Paccanaro M, Varotto L, Bonanno C, et al. Cardiac troponin I as a diagnostic and prognostic marker in severe heart failure. J Heart Lung Transplant 2000;19:644-52.
12. Sato Y, Yamada T, Taniguchi R, Nagai K, Makiyama T, Okada H, et al. Persistently increased serum concentrations of cardiac troponin T in patients with idiopathic dilated cardiomyopathy are predictive of adverse outcomes. Circulation 2001;103:369-74.
13. Missov M, Calzolari C, Pau B. Circulating cardiac troponin I in severe congestive heart failure. Circulation 1997;96:2953-8.
14. Setsuta K, Seino Y, Takahashi N, Ogawa T, Sasaki K, Harada A, et al. Clinical significance of elevated levels of cardiac troponin T in patients with chronic heart failure. Am J Cardiol 1999;84:608-11.
15. Del Carlo CH, O’Connor CM. Cardiac troponins in congestive heart failure. Am Heart J. 1999;138:646–653.
16. Ilva T, Lassus J, Siirilä-Waris K, Melin J, Peuhkurinen K, Pulkki K, et al. Clinical significance of cardiac troponins I and T in acute heart failure. Eur J Heart Fail 2008;10:772-79.
17. Apple FS, Murakami MM, Pearce LA, Herzog CA. Predictive value of cardiac troponin I and T for subsequent death in end-stage renal disease. Circulation 2002;106:2941-5.
18. Brunet P, Oddoze C, Paganelli F, Indreies M, Faure V, Opris-Saveanu A, et al. Cardiac troponins I and T in hemodialysis patients without acute coronary syndrome. Int J Cardiol 2008;129:205-9.
19. Sherwood MW, Kristin Newby L. High-sensitivity troponin assays: evidence, indications, and reasonable use. J Am Heart Assoc 2014;3:e000403
20. Nishio Y, Sato Y, Taniguchi R, Shizuta S, Doi T, Morimoto T, et al. Cardiac troponin T vs other biochemical markers in patients with congestive heart failure. Circ J 2007;71:631-5
21. Thavendiranathan P, Yingchoncharoen T, Grant A, Seicean S, Landers SH, Gorodeski EZ, et al. Prediction of 30-day heart failure-specific readmission risk by echocardiographic parameters. Am J Cardiol 2014;113:335-41
22. Proctor P, King DR, Fesel NM, Narveson SY, Anderson WE, Littmann L. Outcome of Patients Discharged From a Heart Failure Disease Management Program following Their Clinical and Echocardiographic Recovery. Cardiology 2015;131:197-202.
23. Demir M, Kanadasi M, Akpinar O, Do¨nmez Y, Avkarogullari M, Alhan C, et al. Cardiac troponin T as a
prognostic marker in patients with heart failure: a 3-year outcome study. Angiology 2007;58:603-9.
24. Perna ER, Macín SM, Parras JI, Pantich R, Farías EF, Badaracco JR, Jantus E, Medina F, Brizuela M. Cardiac troponin T levels are associated with poor short- and long-term prognosis in patients with acute cardiogenic pulmonary edema. Am Heart J 2002;143:814-20.
25. Gheorghiade M, Gattis Stough W, Adams JKF, Jaffe AS, Hasselblad V, O’Connor CM. The Pilot Randomized Study of Nesiritide Versus Dobutamine in Heart Failure (PRESERVD-HF). Am J Coll Cardiol 2005;96:18-25.
26. Guisado Espartero ME, Salamanca-Bautista P, Aramburu-Bodas O, Arias-Jimenez JL, Formiga F, Roca-Villanueva B, et al. Troponin T in acute heart failure: clinical implications and prognosis in the Spanish National Registry on Heart Failure. Eur J Intern Med 2014;25:739-44.
27. Metra M, Bettari L, Pagani F, Lazzarini V, Lombardi C, Carubelli V, et al. Troponin T levels in patients with acute heart failure: clinical and prognostic significance of their detection and release during hospitalisation. Clin Res Cardiol 2012;101:663-72.
28. Christopher M, O'Connor CM, Fiuzat M, Lombardi C, Fujita K, Jia G, et al. Impact of serial troponin release on outcomes in patients with acute heart failure: analysis from the PROTECT pilot study. Circ Heart Fail 2011;4:724-32.
29. Tsutamoto T, Kawahara C, Nishiyama K, Yamaji M, Fujii M, Yamamoto T, et al. Prognostic role of highly sensitive cardiac troponin I in patients with systolic heart failure. Am Heart J 2010;159:63-7.
30. Parenti N, Bartolacci S, Carle F, Angelo F. Cardiac troponin I as prognostic marker in heart failure patients discharged from emergency department. Intern Emerg Med 2008;3:43-7.
31. Xue Y, Clopton P, Peacock WF, Maisel AS. Serial changes in high-sensitive troponin I predict outcome in patients with decompensated heart failure. Eur J Heart Fail 2011;13:37-42.
32. Wu AH, Ford L. Release of cardiac troponin in acute coronary syndromes: ischemia or necrosis? Clin Chim Acta 1999;284:161-74.
33. Yiu KH, Lau KK, Zhao CT, Chan YH, Chen Y, Zhen Z, Wong A, Lau CP, Tse HF. Predictive value of high-sensitivity troponin-I for future adverse cardiovascular outcome in stable patients with type 2 diabetes mellitus. Cardiovasc Diabetol 2014;13:63.
34. Yiu KH, Zhao CT, Chen Y, Siu CW, Chan YH, Lau KK, et al. Association of subclinical myocardial injury with arterial stiffness in patients with type 2 diabetes mellitus. Cardiovasc Diabetol 2013;12:94.
35. Eggers KM, Nygren M, Venge P, Jernberg T, Wikström BG. High-sensitive troponin T and I are related to invasive hemodynamic data and mortality in patients with left-ventricular dysfunction and precapillary pulmonary hypertension. Clin Chem Acta 2011;412:1582-8.
36. Fox CS, Pencina MJ, Meigs JB, Vasan RS, Levitzky YS, D'Agostino RB Sr. Trends in the incidence of type 2 diabetes mellitus from the 1970s to the 1990s: the framingham heart study. Circulation 2006;113:2914-8.
37. Vasan RS. Biomarkers of cardiovascular disease: molecular basis and practical considerations. Circulation 2006;113:2335-62.
| Files | ||
| Issue | Vol 57, No 2 (2019) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/acta.v57i2.1766 | |
| Keywords | ||
| Decompensated heart failure Troponin I Hospitalization | ||
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How to Cite
1.
Hajsadeghi S, Bagheri Y, Ghafouri MH, Jafarian Kerman SR, Hassanzadeh M. High-Sensitive Troponin I and Re-Hospitalization in Patients With Decompensated Congestive Heart Failure. Acta Med Iran. 2019;57(2):116-121.
