High-Sensitive Troponin I and Re-Hospitalization in Patients With Decompensated Congestive Heart Failure
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.
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.
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.