Abstract 2999: Troponin Profiles in Acute Decompensated Heart Failure: The Relevance of Change
Introduction: Elevated cardiac troponin I (cTnI) level in patients with acute decompensated heart failure (ADHF) has been correlated with the severity of heart failure and worse outcomes. Limited information is available on the profile of subclinical elevation in cTnI (<0.4 ng/ml) in ADHF.
Objective: Determine the profile of cTnI in ADHF and the association between changes in subclinical cTnI leve and outcomes.
Methods: We studied 1000 patients admitted with ADHF to a tertiary care medical center in urban city between January and August 2007. 485 patients had at least two cTnI drawn six to twelve hours apart with the first one obtained at arrival to the ED. Patients were divided into two groups; 423 patients with subclinical cTnI elevation (<0.4 ng/ml) and 62 patients with clinical cTnI elevation (≥0.4 ng/ml). The subclinical elevation was further divided into three categories; no change in cTnI, up trending and the third with down trending of cTnI. One-year mortality was the primary outcome.
Results: Patients with clinical cTnI elevation had significantly higher in-hospital mortality compared to the subclinical cTnI elevation group (8% vs 2.6%, p=0.024). In the subclinical group 412 patients survived the index hospitalization and divided to three categories; 119 patients (29%) had up trending cTnI, 104 patients (25%) had down trending cTnI, and 189 patients (46%) had no change in the cTnI. Compared to One-year mortality of 9.5% in the no change group, it was 17.6% in the up trending cTnI group (p=0.037) and 17.3% in the down trending cTnI group (p=0.052). The following variables were identified as statistically significant predictors of one-year mortality in the logistic regression analysis:
Conclusion: Changes in subclinical cTnI are associated with higher mortality. Subclinical up trending occurs in one third of patients with ADHF and is an independent risk for one-year mortality.