Abstract 14953: Serial Measurement of an Ultrasensitive Cardiac Troponin-I Predicts Cardiovascular Outcomes and Ventricular Remodeling in Chronic Heart Failure
Introduction: Cardiac troponin-I (cTnI) concentrations are prognostically important in patients with heart failure (HF). Newer generation assays have increased sensitivity for detection and discrimination of extremely low cTnI concentrations.
Hypothesis: We assessed the hypothesis that cTnI concentrations measured serially with an ultrasensitive method (Singulex, Alameda, CA) would predict CV events (including HF hospitalization, worsening HF, and CV death) and ventricular remodeling in patients with HF due to left ventricular systolic dysfunction (LVSD), even when adjusted for relevant covariates.
Methods: A total of 99 subjects were followed over 10 ± 3 months. Concentrations of cTnI were considered across study visits, and used to assess risk for adverse cardiovascular (CV) events and LV remodeling.
Results: Every subject had detectable cTnI, and cTnI was above the 99th percentile of a normal population in 56.7% of subjects; median cTnI at baseline was 10.88 pg/mL. Concentrations of cTnI at baseline, 3 months, and 6 months of follow up were higher in patients with CV events than in those without (18.0 vs. 8.6 pg/mL, p = 0.003; 16.4 vs. 8.7 pg/mL, p = 0.006; 13.6 vs. 9.3 pg/mL, p = 0.03). cTnI >10.88 pg/mL was significantly associated with shorter time to first event (Figure A; p = 0.008). Across serial measurements, 33.8% rose or fell relative to the median value, and duration of time spent with cTnI ≤10.88 pg/mL was associated with a lower CV event rate (Figure B; p = 0.007), independently predicting fewer events even after adjustment for traditional CV risk factors (OR = 0.81; p = 0.008). Lastly, rise in cTnI predicted increase in LV end diastolic (OR = 2.53; p = 0.04) and systolic (OR = 4.89; p = 0.008) volume index.
Conclusions: Ultrasensitive cTnI identifies significant myocardial necrosis in a majority of patients with chronic HF due to LVSD. When measured serially, this method provides independent risk information for poor CV outcomes and deleterious LV remodeling.
- © 2013 by American Heart Association, Inc.