Abstract 12021: Changes in Troponin I and Outcomes in Acute Heart Failure: Data from the Pre-RELAX study
Background: Troponin I (cTnI) is a sensitive marker of myocardial injury and has been shown to be elevated in AHF. The clinical significance of changes in cTnI in patients with AHF is uncertain.
Methods: We analyzed cTnI data from 215 patients enrolled in the Pre-RELAX study, a randomized controlled trial of serelaxin vs. placebo in AHF patients with elevated blood pressure (SBP > 125 mmHg). cTnI was measured at baseline, 48 hours, day 5, and day 14 using a contemporary sensitive assay (VITROS Trop I ES, Ortho Clinical Diagnostics) with a lower limit of detection (LLD) of 0.012 ng/mL and a 99% upper reference limit (URL) of 0.034 ng/mL. Multivariate modeling was used to assess the relationship of baseline cTnI, peak cTnI at any time point including baseline, and change from baseline to peak cTnI with clinical outcomes. Log transformed cTnI values were used for these analyses.
Results: Baseline cTnI was elevated above the URL in 56% (n=121), between LLD and URL in 15% (n = 32), and below LLD in 28% (n = 62) of patients. At day 14, 32% of patients had cTnI above the URL, but only 26% of the patients were above URL at both baseline and Day 14. Baseline cTnI was generally not associated with adverse clinical outcomes after adjustment for other covariates. However, peak change from baseline was highly predictive of a variety of important clinical outcomes, even after adjustment for other covariates. The peak troponin at any time point was also predictive, but less so (Table).
Conclusions: Elevated cTnI is common in patients with AHF and elevated blood pressure at presentation, and is observed in a third of the population at Day 14. Although baseline cTnI levels were not generally predictive of outcomes, the peak change in cTnI from baseline was strongly predictive of outcomes, including 180-day mortality. These data have implications for post discharge risk stratification in patients with AHF.
- © 2012 by American Heart Association, Inc.