Abstract 13262: High Sensitivity Troponin I in Acute Decompensated Heart Failure: Insights from the ASCEND-HF Study
Background: Prior data suggest that circulating cardiac troponin (cTn) may be a useful prognostic marker in patients with acute decompensated heart failure (ADHF). Recent improvements in the sensitivity of troponin assays suggest the need for reassessment of the significance of troponin elevation in HF in order to define clinically relevant cut-points. We examined the prognostic importance of high sensitivity troponin I (cTnI) in a cohort of patients enrolled in the ASCEND-HF study, a randomized clinical trial of nesiritide in ADHF.
Methods: cTnI was measured at a central core laboratory in 808 ADHF patients enrolled in the ASCEND-HF study using a contemporary high sensitivity assay (VITROS Trop I ES, Ortho Clinical Diagnostics) with a lower limit of detection of 0.012 ng/mL and a 99% upper reference limit (URL) of 0.034 ng/mL. Logistic regression was used to assess the relationship between log (cTnI) and 30-day mortality.
Results: Baseline cTnI was undetectable in 22% and elevated above the 99% URL in 50%. Patients with cTnI >0.034 ng/mL were more often male, were older, and had higher NTproBNP and worse renal function (p<0.05 for all). Higher log (cTnI) was associated with a higher 30-day mortality in logistic regression (odds ratio=1.23 per doubling of cTnI, p=0.035, c-index=0.60), and there was no evidence for a threshold effect at any level of cTnI (figure). After adjustment for other known predictors using the ASCEND-HF mortality model (age, blood pressure, urea nitrogen, sodium), cTnI was no longer associated with 30-day mortality (adjusted odds ratio=1.19 per doubling of cTnI, p=0.31).
Conclusions: cTnI was associated with 30-day mortality in ADHF, but this effect was no longer significant after multivariable adjustment. There was no evidence for a threshold effect at any level of troponin elevation, suggesting that the 99% URL utilized for the diagnosis of acute MI has no particular significance in patients with ADHF.
- © 2011 by American Heart Association, Inc.