Abstract 12161: Persistent Cardiac Troponin Elevation During Acute Heart Failure Syndrome and Catecholamine Use
Inotrope use and high cardiac troponin concentration are both known prognostic markers for patients with worsening acute heart failure syndrome. However, the relationship between these 2 parameters has not been well studied. We assessed the hypothesis that inotrope use increase cardiomyocytes injury during acute heart failure syndrome. The present prospective observational study included 114 consecutive patients with acute heart failure (male, 51%; age: median, 74 [70-82] years). On the day of admission, on days 4 and 7 after admission, the patients` clinical characteristics and parameters were recorded, and blood and urine samples were collected. Of the 114 patients, 31 required continuous infusion of dobutamine or dopamine for heart failure treatment. After adjusting for these baseline parameters, 31 matched pairs were selected and compared. Serum troponin-I concentration decreased through the course of heart failure (median: 0.038, 0.030, and 0.028 ng/mL, on days 1, 4, and 7, respectively, p = 0.001; MANOVA) in our study population. At admission, the factors independently related to inotrope use included hypotension (with inotrope vs. without, 122 ± 24.7 mmHg vs. 145 ± 24.5 mmHg, p<0.001), higher bilirubin concentration (0.8 [0.7-1.3] mg/dL vs. 0.7 [0.5-1.1] mg/dL, p = 0.036), and higher cardiac troponin-I (0.072 [0.034-0.190] ng/mL vs. 0.031 [0.017-0.075] ng/mL, p = 0.021). Moreover, serum troponin-I concentration decreased further in patients treated without inotrope compared to those treated with inotrope (p = 0.049, MANOVA). In conclusion, low blood pressure, higher bilirubin, and troponin concentration at admission were independent predictors of the need for inotrope administration for acute heart failure treatment. After adjusting for these factors, inotrope use was shown to affect the decrease of cardiac troponin-I in the therapeutic course of acute decompensated heart failure.
- © 2012 by American Heart Association, Inc.