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D’Amato A, Severino P, Prosperi S, Mariani MV, Germanò R, De Prisco A, Myftari V, Cestiè C, Labbro Francia A, Marek-Iannucci S, Tabacco L, Vari L, Marano SL, Di Pietro G, Lavalle C, Sardella G, Mancone M, Badagliacca R, Fedele F, Vizza CD. The Role of High-Sensitivity Troponin T Regarding Prognosis and Cardiovascular Outcome across Heart Failure Spectrum. J Clin Med 2024; 13:3533. [PMID: 38930061 PMCID: PMC11204386 DOI: 10.3390/jcm13123533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Revised: 06/12/2024] [Accepted: 06/14/2024] [Indexed: 06/28/2024] Open
Abstract
Background: Cardiac troponin release is related to the cardiomyocyte loss occurring in heart failure (HF). The prognostic role of high-sensitivity cardiac troponin T (hs-cTnT) in several settings of HF is under investigation. The aim of the study is to assess the prognostic role of intrahospital hs-cTnT in patients admitted due to HF. Methods: In this observational, single center, prospective study, patients hospitalized due to HF have been enrolled. Admission, in-hospital peak, and discharge hs-cTnT have been assessed. Patients were followed up for 6 months. Cardiovascular (CV) death, HF hospitalization (HFH), and worsening HF (WHF) (i.e., urgent ambulatory visit/loop diuretics escalation) events have been assessed at 6-month follow up. Results: 253 consecutive patients have been enrolled in the study. The hs-cTnT median values at admission and discharge were 0.031 ng/mL (IQR 0.02-0.078) and 0.031 ng/mL (IQR 0.02-0.077), respectively. The risk of CV death/HFH was higher in patients with admission hs-cTnT values above the median (p = 0.02) and in patients who had an increase in hs-cTnT during hospitalization (p = 0.03). Multivariate Cox regression analysis confirmed that hs-cTnT above the median (OR: 2.06; 95% CI: 1.02-4.1; p = 0.04) and increase in hs-cTnT during hospitalization (OR:1.95; 95%CI: 1.006-3.769; p = 0.04) were predictors of CV death/HFH. In a subgroup analysis of patients with chronic HF, hs-cTnT above the median was associated with increased risk of CV death/HFH (p = 0.03), while in the subgroup of patients with HFmrEF/HFpEF, hs-cTnT above the median was associated with outpatient WHF events (p = 0.03). Conclusions: Inpatient hs-cTnT levels predict CV death/HFH in patients with HF. In particular, in the subgroup of chronic HF patients, hs-cTnT is predictive of CV death/HFH; while in patients with HFmrEF/HFpEF, hs-cTnT predicts WHF events.
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Affiliation(s)
- Andrea D’Amato
- Department of Clinical, Internal, Anaesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (P.S.); (S.P.); (R.G.); (A.D.P.); (V.M.); (C.C.); (A.L.F.); (S.M.-I.); (L.T.); (L.V.); (S.L.M.); (G.D.P.); (C.L.); (G.S.); (M.M.); (R.B.); (C.D.V.)
- Department of Cardiology, Ospedale Fabrizio Spaziani, 03100 Frosinone, Italy
| | - Paolo Severino
- Department of Clinical, Internal, Anaesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (P.S.); (S.P.); (R.G.); (A.D.P.); (V.M.); (C.C.); (A.L.F.); (S.M.-I.); (L.T.); (L.V.); (S.L.M.); (G.D.P.); (C.L.); (G.S.); (M.M.); (R.B.); (C.D.V.)
| | - Silvia Prosperi
- Department of Clinical, Internal, Anaesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (P.S.); (S.P.); (R.G.); (A.D.P.); (V.M.); (C.C.); (A.L.F.); (S.M.-I.); (L.T.); (L.V.); (S.L.M.); (G.D.P.); (C.L.); (G.S.); (M.M.); (R.B.); (C.D.V.)
| | - Marco Valerio Mariani
- Department of Clinical, Internal, Anaesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (P.S.); (S.P.); (R.G.); (A.D.P.); (V.M.); (C.C.); (A.L.F.); (S.M.-I.); (L.T.); (L.V.); (S.L.M.); (G.D.P.); (C.L.); (G.S.); (M.M.); (R.B.); (C.D.V.)
| | - Rosanna Germanò
- Department of Clinical, Internal, Anaesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (P.S.); (S.P.); (R.G.); (A.D.P.); (V.M.); (C.C.); (A.L.F.); (S.M.-I.); (L.T.); (L.V.); (S.L.M.); (G.D.P.); (C.L.); (G.S.); (M.M.); (R.B.); (C.D.V.)
| | - Andrea De Prisco
- Department of Clinical, Internal, Anaesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (P.S.); (S.P.); (R.G.); (A.D.P.); (V.M.); (C.C.); (A.L.F.); (S.M.-I.); (L.T.); (L.V.); (S.L.M.); (G.D.P.); (C.L.); (G.S.); (M.M.); (R.B.); (C.D.V.)
| | - Vincenzo Myftari
- Department of Clinical, Internal, Anaesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (P.S.); (S.P.); (R.G.); (A.D.P.); (V.M.); (C.C.); (A.L.F.); (S.M.-I.); (L.T.); (L.V.); (S.L.M.); (G.D.P.); (C.L.); (G.S.); (M.M.); (R.B.); (C.D.V.)
| | - Claudia Cestiè
- Department of Clinical, Internal, Anaesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (P.S.); (S.P.); (R.G.); (A.D.P.); (V.M.); (C.C.); (A.L.F.); (S.M.-I.); (L.T.); (L.V.); (S.L.M.); (G.D.P.); (C.L.); (G.S.); (M.M.); (R.B.); (C.D.V.)
| | - Aurora Labbro Francia
- Department of Clinical, Internal, Anaesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (P.S.); (S.P.); (R.G.); (A.D.P.); (V.M.); (C.C.); (A.L.F.); (S.M.-I.); (L.T.); (L.V.); (S.L.M.); (G.D.P.); (C.L.); (G.S.); (M.M.); (R.B.); (C.D.V.)
| | - Stefanie Marek-Iannucci
- Department of Clinical, Internal, Anaesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (P.S.); (S.P.); (R.G.); (A.D.P.); (V.M.); (C.C.); (A.L.F.); (S.M.-I.); (L.T.); (L.V.); (S.L.M.); (G.D.P.); (C.L.); (G.S.); (M.M.); (R.B.); (C.D.V.)
| | - Leonardo Tabacco
- Department of Clinical, Internal, Anaesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (P.S.); (S.P.); (R.G.); (A.D.P.); (V.M.); (C.C.); (A.L.F.); (S.M.-I.); (L.T.); (L.V.); (S.L.M.); (G.D.P.); (C.L.); (G.S.); (M.M.); (R.B.); (C.D.V.)
| | - Leonardo Vari
- Department of Clinical, Internal, Anaesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (P.S.); (S.P.); (R.G.); (A.D.P.); (V.M.); (C.C.); (A.L.F.); (S.M.-I.); (L.T.); (L.V.); (S.L.M.); (G.D.P.); (C.L.); (G.S.); (M.M.); (R.B.); (C.D.V.)
| | - Silvia Luisa Marano
- Department of Clinical, Internal, Anaesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (P.S.); (S.P.); (R.G.); (A.D.P.); (V.M.); (C.C.); (A.L.F.); (S.M.-I.); (L.T.); (L.V.); (S.L.M.); (G.D.P.); (C.L.); (G.S.); (M.M.); (R.B.); (C.D.V.)
| | - Gianluca Di Pietro
- Department of Clinical, Internal, Anaesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (P.S.); (S.P.); (R.G.); (A.D.P.); (V.M.); (C.C.); (A.L.F.); (S.M.-I.); (L.T.); (L.V.); (S.L.M.); (G.D.P.); (C.L.); (G.S.); (M.M.); (R.B.); (C.D.V.)
| | - Carlo Lavalle
- Department of Clinical, Internal, Anaesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (P.S.); (S.P.); (R.G.); (A.D.P.); (V.M.); (C.C.); (A.L.F.); (S.M.-I.); (L.T.); (L.V.); (S.L.M.); (G.D.P.); (C.L.); (G.S.); (M.M.); (R.B.); (C.D.V.)
| | - Gennaro Sardella
- Department of Clinical, Internal, Anaesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (P.S.); (S.P.); (R.G.); (A.D.P.); (V.M.); (C.C.); (A.L.F.); (S.M.-I.); (L.T.); (L.V.); (S.L.M.); (G.D.P.); (C.L.); (G.S.); (M.M.); (R.B.); (C.D.V.)
| | - Massimo Mancone
- Department of Clinical, Internal, Anaesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (P.S.); (S.P.); (R.G.); (A.D.P.); (V.M.); (C.C.); (A.L.F.); (S.M.-I.); (L.T.); (L.V.); (S.L.M.); (G.D.P.); (C.L.); (G.S.); (M.M.); (R.B.); (C.D.V.)
| | - Roberto Badagliacca
- Department of Clinical, Internal, Anaesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (P.S.); (S.P.); (R.G.); (A.D.P.); (V.M.); (C.C.); (A.L.F.); (S.M.-I.); (L.T.); (L.V.); (S.L.M.); (G.D.P.); (C.L.); (G.S.); (M.M.); (R.B.); (C.D.V.)
| | | | - Carmine Dario Vizza
- Department of Clinical, Internal, Anaesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (P.S.); (S.P.); (R.G.); (A.D.P.); (V.M.); (C.C.); (A.L.F.); (S.M.-I.); (L.T.); (L.V.); (S.L.M.); (G.D.P.); (C.L.); (G.S.); (M.M.); (R.B.); (C.D.V.)
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Hong J, Chatila KF, John JJ, Thakker RA, Kassem H. Insight on the Etiologies of Chronically Elevated Troponin. Curr Probl Cardiol 2022:101204. [DOI: 10.1016/j.cpcardiol.2022.101204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 04/02/2022] [Indexed: 01/12/2023]
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Hill L, Prager Geller T, Baruah R, Beattie JM, Boyne J, de Stoutz N, Di Stolfo G, Lambrinou E, Skibelund AK, Uchmanowicz I, Rutten FH, Čelutkienė J, Piepoli MF, Jankowska EA, Chioncel O, Ben Gal T, Seferovic PM, Ruschitzka F, Coats AJS, Strömberg A, Jaarsma T. Integration of a palliative approach into heart failure care: a European Society of Cardiology Heart Failure Association position paper. Eur J Heart Fail 2020; 22:2327-2339. [PMID: 32892431 DOI: 10.1002/ejhf.1994] [Citation(s) in RCA: 85] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 08/27/2020] [Accepted: 08/29/2020] [Indexed: 12/18/2022] Open
Abstract
The Heart Failure Association of the European Society of Cardiology has published a previous position paper and various guidelines over the past decade recognizing the value of palliative care for those affected by this burdensome condition. Integrating palliative care into evidence-based heart failure management remains challenging for many professionals, as it includes the identification of palliative care needs, symptom control, adjustment of drug and device therapy, advance care planning, family and informal caregiver support, and trying to ensure a 'good death'. This new position paper aims to provide day-to-day practical clinical guidance on these topics, supporting the coordinated provision of palliation strategies as goals of care fluctuate along the heart failure disease trajectory. The specific components of palliative care for symptom alleviation, spiritual and psychosocial support, and the appropriate modification of guideline-directed treatment protocols, including drug deprescription and device deactivation, are described for the chronic, crisis and terminal phases of heart failure.
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Affiliation(s)
- Loreena Hill
- School of Nursing and Midwifery, Queen's University, Belfast, UK
| | - Tal Prager Geller
- Palliative Care Ward at Dorot Health Centre, Heart Failure Unit at Rabin Medical Center, Netanya, Israel
| | - Resham Baruah
- Chelsea and Westminster NHS Foundation Trust, London, UK
| | - James M Beattie
- Cicely Saunders Institute, King's College London, London, UK
| | - Josiane Boyne
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | | | - Giuseppe Di Stolfo
- Cardiovascular Department, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | | | | | - Izabella Uchmanowicz
- Faculty of Health Sciences, Wroclaw Medical University, Wroclaw, Poland.,Centre for Heart Diseases, University Hospital, Wroclaw, Poland
| | - Frans H Rutten
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Jelena Čelutkienė
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Massimo Francesco Piepoli
- Heart Failure Unit, Cardiology, Guglielmo da Saliceto Hospital, Piacenza, Italy.,University of Parma, Parma, Italy
| | - Ewa A Jankowska
- Centre for Heart Diseases, University Hospital, Wroclaw, Poland.,Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Ovidiu Chioncel
- Emergency Institute for Cardiovascular Diseases 'Prof. C.C. Iliescu', Bucharest, Romania.,University of Medicine Carol Davila, Bucharest, Romania
| | - Tuvia Ben Gal
- Heart Failure Unit, Cardiology Department, Rabin Medical Center, Petah Tikva and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Petar M Seferovic
- Cardiology Department, Clinical Centre Serbia, Medical School Belgrade, Belgrade, Serbia
| | - Frank Ruschitzka
- Clinic for Cardiology, University Hospital Zurich, Zurich, Switzerland
| | | | - Anna Strömberg
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Tiny Jaarsma
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Julius Center, University Medical Center Utrecht, Utrecht, The Netherlands
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Is Cardiac Troponin I Valuable to Detect Low-Level Myocardial Damage in Congestive Heart Failure? MEDICAL BULLETIN OF SISLI ETFAL HOSPITAL 2019; 53:172-178. [PMID: 32377078 PMCID: PMC7199837 DOI: 10.14744/semb.2018.45336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 10/19/2018] [Indexed: 12/31/2022]
Abstract
Objectives: Congestive heart failure (CHF) is a heart disease with a growing incidence and prevalence. Creatine kinase-myocardial base (CK-MB) is generally used to determine myocardial damage; however, it is insufficiently sensitive to measure the relatively low level of myocardial damage that typically occurs in heart failure (HF). The use of cardiac troponins, which are far more sensitive and specific, has become common to identify myocardial damage and permits the detection of even minute amounts of damage. The aim of this study was to ascertain whether cardiac troponin I (cTnI) can be used to detect low-level myocardial damage occurring in CHF in real-life conditions. Methods: Fifty patients with CHF symptoms (Group I) and 20 patients who were evaluated as normal (Group II) were included in this prospective study. The Framingham criteria were used to diagnose HF. Group I was divided into 3 subgroups according to the New York Heart Association classification of functional capacity: Class II, Group A; Class III, Group B, and Class IV, Group C. On the first day of admission, CK-MB and cTnI levels were measured and assessed quantitatively. The cTnI level was compared between these 3 subgroups and between Groups I and II. Linear regression analysis was performed to investigate the relationship between ejection fraction (EF) and cTnI. Results The mean cTnI value was 0.084±0.07 ng/mL in Group I and 0.018±0.012 ng/mL in Group II (p=0.0001). The mean cTnI value was 0.047±0.016 ng/mL, 0.080±0.048 ng/mL, and 0.175± 0.102 ng/mL in Groups A, B, and C, respectively. The difference between the subgroups of Group I was statistically significant. In addition, it was observed that there was a significant difference in the EF (%) value between Groups I and II and between Groups A, B, and C. Linear regression analysis revealed an inverse relationship between EF and cTnI (r: -0.66) (p=0.0001). Conclusion As the severity of HF increased, the cTnI serum level also increased. This increase was inversely related to the EF value. These results are consistent with other studies in the literature, suggesting that the cTnI level may be a useful marker in the diagnosis and evaluation of severity of HF.
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Su A, Al'Aref SJ, Beecy AN, Min JK, Karas MG. Clinical and Socioeconomic Predictors of Heart Failure Readmissions: A Review of Contemporary Literature. Mayo Clin Proc 2019; 94:1304-1320. [PMID: 31272573 DOI: 10.1016/j.mayocp.2019.01.017] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 12/10/2018] [Accepted: 01/21/2019] [Indexed: 12/28/2022]
Abstract
Heart failure represents a clinical syndrome that results from a constellation of disease processes affecting myocardial function. Although recent studies have suggested a declining or stable incidence of heart failure, patients with heart failure continue to have high hospitalization and readmission rates, resulting in a substantial economic and public health burden. We searched PubMed and Google Scholar to identify published literature from 1998 through 2018 using the following keywords: heart failure, readmissions, predictors, prediction models, and interventions. Cited references were also used to identify relevant literature. Developments in the diagnosis and management of patients with heart failure have improved hospitalization and readmission rates in the past few decades. However, heart failure remains the most common cause of hospitalization in persons older than 65 years. As a result, given the enormous clinical and financial burden associated with heart failure readmissions on health care, there has been growing interest in the investigation of mechanisms aimed at improving outcomes and curtailing associated costs of care. Herein, we review the current literature on clinical and socioeconomic predictors of heart failure readmissions, briefly discussing limitations of existing strategies and providing an overview of current technology aimed at reducing hospitalizations.
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Affiliation(s)
- Amanda Su
- Dalio Institute of Cardiovascular Imaging, NewYork-Presbyterian Hospital, New York, NY
| | - Subhi J Al'Aref
- Dalio Institute of Cardiovascular Imaging, NewYork-Presbyterian Hospital, New York, NY; Department of Medicine, Weill Cornell Medicine, New York, NY; Department of Radiology, Weill Cornell Medicine, New York, NY
| | - Ashley N Beecy
- Dalio Institute of Cardiovascular Imaging, NewYork-Presbyterian Hospital, New York, NY; Department of Cardiology, Weill Cornell Medicine, New York, NY
| | - James K Min
- Dalio Institute of Cardiovascular Imaging, NewYork-Presbyterian Hospital, New York, NY; Department of Medicine, Weill Cornell Medicine, New York, NY; Department of Radiology, Weill Cornell Medicine, New York, NY
| | - Maria G Karas
- Department of Cardiology, Weill Cornell Medicine, New York, NY.
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Jansen van Vuren E, Malan L, von Känel R, Magnusson M, Lammertyn L, Malan NT. BDNF increases associated with constant troponin T levels and may protect against poor cognitive interference control: The SABPA prospective study. Eur J Clin Invest 2019; 49:e13116. [PMID: 30932178 DOI: 10.1111/eci.13116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Revised: 02/13/2019] [Accepted: 03/28/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Brain-derived neurotrophic factor (BDNF) modulates brain health and cognition, which can interfere with executive cognitive function. BDNF was implicated with microcirculatory ischaemia and may reflect cardiomyocyte injury. We aimed to determine whether prospective changes (%Δ) in BDNF and cardiac troponin T (cTnT) will be associated with executive cognitive function in a bi-ethnic cohort. DESIGN A prospective investigation was conducted over a three-year period in a bi-ethnic sex cohort (N = 338; aged 20-65 years) from South Africa. Fasting serum samples for BDNF and cTnT were obtained. The STROOP-color-word conflict test (CWT) was applied to assess executive cognitive function at baseline. RESULTS In Blacks, BDNF (P < 0.001) increased over the three-year period while cTnT did not change. In contrast, in Whites, BDNF and cTnT decreased over three years. In Black men, no change in cTnT was associated with increased ΔBDNF (β = 0.25; 95% CI 0.05-0.45; P = 0.02). In the Black men, constant cTnT levels were inversely associated with executive cognitive function (β = -0.33; 95% CI -0.53 to -0.12; P = 0.003). Three-year increases in BDNF increased the likelihood for chronic lower cTnT levels at a pre-established cut-point of <4.2 ng/L [OR = 2.35 (1.12-4.94), P = 0.02]. The above associations were not found in the White sex groups. CONCLUSIONS Central neural control mechanisms may have upregulated BDNF in Black men as a way to protect against myocardial stress progression and to possibly improve processes related to cognitive interference control. High-sensitive cTnT levels may act as an early predictor of disturbed neural control mechanisms.
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Affiliation(s)
- Esmé Jansen van Vuren
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
| | - Leoné Malan
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
| | - Roland von Känel
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa.,Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Switzerland
| | - Martin Magnusson
- Department of Cardiology, Skåne University Hospital, Malmö, Sweden.,Department of Clinical Sciences, Lund University, Malmö, Sweden.,Wallenberg Centre for Molecular Medicine, Lund University, Malmö, Sweden
| | - Leandi Lammertyn
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa.,MRC Research Unit for Hypertension and Cardiovascular Disease, North-West University (Potchefstroom Campus), Potchefstroom, South Africa
| | - Nicolaas T Malan
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
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O'Connor CM. Development of Acute Decompensated Heart Failure Therapies: Is the Journey Over? JACC-HEART FAILURE 2018; 5:464-465. [PMID: 28571600 DOI: 10.1016/j.jchf.2017.04.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Yang CW, Li H, Thomas L, Ramos M, Liu PH, Roe T, Valadri R, Kiel MC, Su VYF, Shi Q. Retrospective cause analysis of troponin I elevation in non-CAD patients: Special emphasis on sepsis. Medicine (Baltimore) 2017; 96:e8027. [PMID: 28906388 PMCID: PMC5604657 DOI: 10.1097/md.0000000000008027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Troponin I is one of the most commonly tested biochemical markers in the emergency room (ER) and in the hospital setting. Besides coronary artery disease (CAD), demand ischemia with underlying tachycardia, anemia, hypertensive emergency, congestive heart failure, kidney disease, sepsis, and pulmonary embolism have also been reported to cause troponin I elevations. Few reports have excluded patients with CAD, and no study has summarized the proportion of these factors relative to an increased troponin I level. METHODS The aim of this retrospective study was to investigate the level of contribution of causative factors in troponin I elevation. Charts of patients tested for troponin I during an ER visit or during hospitalization were collected. Patients with known CAD, abnormal stress tests, cardiac catheterizations, or discharge without an adequate cardiac evaluation were excluded. Logistic regression was used to identify predictors of elevated troponin I levels. RESULTS A total of 586 patients were investigated in this study. Age, hemoglobin (Hb), heart rate (HR), glomerularfiltration rate, atrial fibrillation, congestive heart failure (CHF), and sepsis were significant predictors of elevated troponin I by analysis in univariate logistic regression (all P < .001). In multivariate logistic regression, sepsis, CHF, age, Hb, and HR were independent predictors of troponin I (all P < .01). A simple clinical scoring system was generated with 1 score on patients with age ≥ 60, Hb < 10 g/dL, and HR ≥ 100 beats per minute (bpm). The prevalence of elevated troponin I was 4%, 16%, 38%, and 50% for patients with scores of 0, 1, 2, and 3, respectively. In patients without sepsis and CHF, the chances of elevated troponin I were 2%, 11%, 28%, and 43%. CONCLUSIONS Sepsis was found to be the strongest independent cause of elevated troponin I levels in non-CAD patients. The scoring system composed of age, hemoglobin (Hb), and heart rate (HR) can assist clinical evaluation of elevated troponin I test in non-CAD patients.
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Affiliation(s)
- Chien-Wen Yang
- Department of Internal Medicine, The Wright Center for Graduate Medical Education (WCGME), Scranton
| | - Huijun Li
- Department of Internal Medicine, The Wright Center for Graduate Medical Education (WCGME), Scranton
| | - Lisa Thomas
- Hematology & Oncology Associates of Northeast Pennsylvania
| | - Manuel Ramos
- Department of Internal Medicine, The Wright Center for Graduate Medical Education (WCGME), Scranton
| | - Po-Hong Liu
- Department of Epidemiology, Harvard T.H. Chan School of Public Health
| | - Thomas Roe
- Commonwealth Health Physician Network Great Valley Cardiology
| | | | | | | | - Qi Shi
- Department of Internal Medicine, The Wright Center for Graduate Medical Education (WCGME), Scranton
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9
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Treece J, Chemchirian H, Hamilton N, Jbara M, Gangadharan V, Paul T, Baumrucker SJ. A Review of Prognostic Tools in Heart Failure. Am J Hosp Palliat Care 2017; 35:514-522. [PMID: 28554221 DOI: 10.1177/1049909117709468] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
A minority of patients with end-stage disease are referred to palliative medicine for consultation in advanced heart failure. Educating stakeholders, including primary care, cardiology, and critical care of the benefits of hospice and palliative medicine for patients with poor prognosis, may increase appropriately timed referrals and improve quality of life for these patients. This article reviews multiple tools useful in prognostication in the setting of advanced heart failure.
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Affiliation(s)
- Jennifer Treece
- 1 Department of Internal Medicine, East Tennessee State University, Johnson City, TN, USA
| | - Hrak Chemchirian
- 2 Department of Cardiology, Charleston Area Medical Center, Charleston, WV, USA
| | - Neil Hamilton
- 1 Department of Internal Medicine, East Tennessee State University, Johnson City, TN, USA
| | - Manar Jbara
- 3 Department of Cardiology, ETSU College of Medicine, Johnson City, TN, USA
| | | | - Timir Paul
- 3 Department of Cardiology, ETSU College of Medicine, Johnson City, TN, USA
| | - Steven J Baumrucker
- 5 Department of Hospice and Palliative Medicine, Wellmont Health System, Kingsport, TN, USA
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Chow SL, Maisel AS, Anand I, Bozkurt B, de Boer RA, Felker GM, Fonarow GC, Greenberg B, Januzzi JL, Kiernan MS, Liu PP, Wang TJ, Yancy CW, Zile MR. Role of Biomarkers for the Prevention, Assessment, and Management of Heart Failure: A Scientific Statement From the American Heart Association. Circulation 2017; 135:e1054-e1091. [PMID: 28446515 DOI: 10.1161/cir.0000000000000490] [Citation(s) in RCA: 362] [Impact Index Per Article: 51.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND PURPOSE Natriuretic peptides have led the way as a diagnostic and prognostic tool for the diagnosis and management of heart failure (HF). More recent evidence suggests that natriuretic peptides along with the next generation of biomarkers may provide added value to medical management, which could potentially lower risk of mortality and readmissions. The purpose of this scientific statement is to summarize the existing literature and to provide guidance for the utility of currently available biomarkers. METHODS The writing group used systematic literature reviews, published translational and clinical studies, clinical practice guidelines, and expert opinion/statements to summarize existing evidence and to identify areas of inadequacy requiring future research. The panel reviewed the most relevant adult medical literature excluding routine laboratory tests using MEDLINE, EMBASE, and Web of Science through December 2016. The document is organized and classified according to the American Heart Association to provide specific suggestions, considerations, or contemporary clinical practice recommendations. RESULTS A number of biomarkers associated with HF are well recognized, and measuring their concentrations in circulation can be a convenient and noninvasive approach to provide important information about disease severity and helps in the detection, diagnosis, prognosis, and management of HF. These include natriuretic peptides, soluble suppressor of tumorgenicity 2, highly sensitive troponin, galectin-3, midregional proadrenomedullin, cystatin-C, interleukin-6, procalcitonin, and others. There is a need to further evaluate existing and novel markers for guiding therapy and to summarize their data in a standardized format to improve communication among researchers and practitioners. CONCLUSIONS HF is a complex syndrome involving diverse pathways and pathological processes that can manifest in circulation as biomarkers. A number of such biomarkers are now clinically available, and monitoring their concentrations in blood not only can provide the clinician information about the diagnosis and severity of HF but also can improve prognostication and treatment strategies.
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11
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Zhou R, Ma P, Xiong A, Xu Y, Wang Y, Xu Q. Protective effects of low-dose rosuvastatin on isoproterenol-induced chronic heart failure in rats by regulation of DDAH-ADMA-NO pathway. Cardiovasc Ther 2017; 35. [PMID: 27957828 DOI: 10.1111/1755-5922.12241] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 12/01/2016] [Accepted: 12/02/2016] [Indexed: 11/26/2022] Open
Abstract
AIMS Cardiovascular disease is the leading cause of death with high morbidity and mortality, and chronic heart failure is the terminal phase of it. This study aimed to investigate the protective effects of the low-dose rosuvastatin on isoproterenol-induced chronic heart failure and to explore the possible related mechanisms. METHODS Male Sprague Dawley rats were given isoproterenol 5 mg/kg once a day for 7 days to establish heart failure model by subcutaneous injection. Simultaneously, low-dose rosuvastatin (5 mg/kg) was orally administrated from day 1 to day 14. Protective effects were evaluated by hemodynamic parameter, histopathological variables, serum asymmetric dimethylarginine (ADMA), cardiac troponin I (cTnI), brain natriuretic peptide (BNP) and myocardial nitric oxide (NO), and the levels of dimethylarginine dimethylaminohydrolase 2 (DDAH2), arginine methyltransferases 1 (PRMT1) and endothelial nitric oxide synthase (eNOS) expression were analyzed. RESULTS Therapeutic rosuvastatin (5 mg/kg) significantly attenuated isoproterenol-induced hypertrophy, remodeling and dysfunction of ventricle, reduced the increased serum content of ADMA, cTnI, and BNP, and elevated myocardial NO in rats (P<.05). Besides, rosuvastatin also significantly inhibited fibrosis of myocardium, normalized the increased PRMT1 and decreased DDAH2 expression. CONCLUSIONS Low-dose rosuvastatin exerted cardioprotective effects on isoproterenol-induced heart failure in rats by modulating DDAH-ADMA-NO pathway, and it may present the new therapeutic value in ameliorating chronic heart failure.
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MESH Headings
- Amidohydrolases/metabolism
- Animals
- Biomarkers/blood
- Cardiotonic Agents/pharmacology
- Disease Models, Animal
- Fibrosis
- Heart Failure/chemically induced
- Heart Failure/enzymology
- Heart Failure/physiopathology
- Heart Failure/prevention & control
- Hypertrophy, Left Ventricular/chemically induced
- Hypertrophy, Left Ventricular/enzymology
- Hypertrophy, Left Ventricular/physiopathology
- Hypertrophy, Left Ventricular/prevention & control
- Isoproterenol
- Male
- Myocardium/enzymology
- Myocardium/pathology
- Natriuretic Peptide, Brain/blood
- Nitric Oxide/metabolism
- Nitric Oxide Synthase Type III/metabolism
- Protein-Arginine N-Methyltransferases/metabolism
- Rats, Sprague-Dawley
- Rosuvastatin Calcium/pharmacology
- Troponin I/blood
- Ventricular Dysfunction, Left/chemically induced
- Ventricular Dysfunction, Left/enzymology
- Ventricular Dysfunction, Left/physiopathology
- Ventricular Dysfunction, Left/prevention & control
- Ventricular Function, Left/drug effects
- Ventricular Pressure/drug effects
- Ventricular Remodeling/drug effects
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Affiliation(s)
- Ru Zhou
- Department of Pharmacology, School of Pharmacy, Ningxia Medical University, Yinchuan, China
- Key Laboratory of Hui Ethnic Medicine Modernization, Ministry of Education, Ningxia Medical University, Yinchuan, China
- Ningxia Hui Medicine Modern Engineering Research Center and Collaborative Innovation Center, Ningxia Medical University, Yinchuan, China
| | - Ping Ma
- Department of Cardiology, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Aiqin Xiong
- Department of Cardiology, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Yehua Xu
- Department of Cardiology, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Yang Wang
- Department of Cardiology, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Qingbin Xu
- Department of Cardiology, General Hospital of Ningxia Medical University, Yinchuan, China
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12
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Hyperpulsatile pressure, systemic inflammation and cardiac stress are associated with cardiac wall remodeling in an African male cohort: the SABPA study. Hypertens Res 2016; 39:648-53. [PMID: 27169396 DOI: 10.1038/hr.2016.45] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Revised: 03/08/2016] [Accepted: 03/11/2016] [Indexed: 12/19/2022]
Abstract
Inflammation may contribute to an increase in cardiac wall stress through pathways related to cardiac remodeling. Cardiac remodeling is characterized by myocyte hypertrophy, myocyte death and modifications of the extracellular matrix. We sought to explore associations among cardiac remodeling, inflammation and myocardial cell injury in a bi-ethnic cohort of South African men and women. We included 165 men (76 African and 89 Caucasian) and 174 women (80 African and 94 Caucasian) between 20 and 65 years of age. Inflammatory markers used were C-reactive protein (CRP), interleukin-6 and tumor necrosis factor-alpha (TNF-α), whereas troponin T (Trop T) and the N-terminal of pro B-type natriuretic peptide (NT-proBNP) were used as cardiac markers. The frequency of ischemic events (ST segment depression) and left ventricular strain (left ventricular hypertrophy: LVH) were monitored by a 24-h recording of ambulatory blood pressure (BP), ECG and 12-lead standard ECG. Hypertension diagnosed with ambulatory monitoring was more frequent in Africans (53.85 vs. 24.59%; P<0.001), as was the number of ischemic events (6±15 (1; 5) vs. 3±6 (0; 3)). Inflammatory markers (CRP, IL-6 and TNF-α) and the degree of LVH were all significantly higher in Africans (P<0.05). BP was associated (P<0.05) with Trop T in men across ethnic groups. In African men, cardiac stress (NT-proBNP) was associated with TNF-alpha (P<0.001), Trop T (P<0.001) and pulse pressure (P=0.048; adjusted R(2)=0.45). The susceptibility for cardiac wall remodeling appears to increase with hyperpulsatile pressure, low-grade systemic inflammation and ventricular stress, and may lead to the development of future cardiovascular events in African men.
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Kasama S, Toyama T, Funada R, Takama N, Koitabashi N, Ichikawa S, Suzuki Y, Matsumoto N, Sato Y, Kurabayashi M. Effects of adding intravenous nicorandil to standard therapy on cardiac sympathetic nerve activity and myocyte dysfunction in patients with acute decompensated heart failure. Eur J Nucl Med Mol Imaging 2015; 42:761-70. [DOI: 10.1007/s00259-015-2990-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 01/07/2015] [Indexed: 02/07/2023]
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Negi S, Sawano M, Kohsaka S, Inohara T, Shiraishi Y, Kohno T, Maekawa Y, Sano M, Yoshikawa T, Fukuda K. Prognostic implication of physical signs of congestion in acute heart failure patients and its association with steady-state biomarker levels. PLoS One 2014; 9:e96325. [PMID: 24802880 PMCID: PMC4011709 DOI: 10.1371/journal.pone.0096325] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Accepted: 04/05/2014] [Indexed: 11/30/2022] Open
Abstract
Background Congestive physical findings such as pulmonary rales and third heart sound (S3) are hallmarks of acute heart failure (AHF). However, their role in outcome prediction remains unclear. We sought to investigate the association between congestive physical findings upon admission, steady-state biomarkers at the time of discharge, and long-term outcomes in AHF patients. Methods We analyzed the data of 133 consecutive AHF patients with an established diagnosis of ischemic or non-ischemic (dilated or hypertrophic) cardiomyopathy, admitted to a single-center university hospital between 2006 and 2010. The treating physician prospectively recorded major symptoms and congestive physical findings of AHF: paroxysmal nocturnal dyspnea, orthopnea, pulmonary rales, jugular venous distension (JVD), S3, and edema. The primary endpoint was defined as rehospitalization for HF. Results Majority (63.9%) of the patients had non-ischemic etiology and, at the time of admission, S3 was seen in 69.9% of the patients, JVD in 54.1%, and pulmonary rales in 43.6%. The mean follow-up period was 726 ± 31days. Patients with pulmonary rales (p < 0.001) and S3 (p = 0.011) had worse readmission rates than those without these findings; the presence of these findings was also associated with elevated troponin T (TnT) levels at the time of discharge (odds ratio [OR] 2.8; p = 0.02 and OR 2.6; p = 0.05, respectively). Conclusion Pulmonary rales and S3 were associated with inferior readmission rates and elevated TnT levels on discharge. The worsening of the readmission rate owing to congestive physical findings may be a consequence of on-going myocardial injury.
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Affiliation(s)
- Sayoko Negi
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Mitsuaki Sawano
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
- * E-mail:
| | - Taku Inohara
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Yasuyuki Shiraishi
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Takashi Kohno
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Yuichiro Maekawa
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Motoaki Sano
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | | | - Keiichi Fukuda
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
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Li X, Luo R, Jiang R, Kong H, Tang Y, Shu Y, Hua W. The prognostic use of serum concentrations of cardiac troponin-I, CK-MB and myoglobin in patients with idiopathic dilated cardiomyopathy. Heart Lung 2014; 43:219-24. [DOI: 10.1016/j.hrtlng.2014.03.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Revised: 02/28/2014] [Accepted: 03/01/2014] [Indexed: 11/28/2022]
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16
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Scheven L, de Jong PE, Hillege HL, Lambers Heerspink HJ, van Pelt LJ, Kootstra JE, Bakker SJL, Gansevoort RT. High-sensitive troponin T and N-terminal pro-B type natriuretic peptide are associated with cardiovascular events despite the cross-sectional association with albuminuria and glomerular filtration rate. Eur Heart J 2012; 33:2272-81. [PMID: 22740385 DOI: 10.1093/eurheartj/ehs163] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
AIMS It has been suggested that troponins and natriuretic peptides can be falsely elevated in subjects with impaired kidney function because of decreased renal clearance. The value of these biomarkers in subjects with impaired kidney function has therefore been debated. We tested in a population-based cohort study, first, whether high-sensitive troponin T (hsTnT) and N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) levels are cross-sectionally associated with the estimated glomerular filtration rate (eGFR) and albuminuria, and secondly, whether these markers are associated with cardiovascular outcome, independent of eGFR, albuminuria and conventional cardiovascular risk factors. METHODS AND RESULTS We included 8121 subjects from the PREVEND study with both values of hsTnT and NT-pro-BNP available. High-sensitive troponin T >0.01 µg/L and NT-pro-BNP >125 ng/L were defined as elevated. We first performed linear regression analyses with hsTnT and NT-pro-BNP as dependent variables. Next, we performed Cox-regression analyses, studying the associations of hsTnT and NT-pro-BNP with incident cardiovascular events. Of our cohort, 6.7% had an elevated hsTnT and 12.2% an elevated NT-pro-BNP. Also, the estimated glomerular filtration rate, albuminuria, and ECG-assessed ischaemia and left ventricular hypertrophy were all significantly associated with hsTnT and NT-pro-BNP in the linear regression analyses. Both hsTnT and NT-pro-BNP appeared associated with cardiovascular events, and these associations remained significant after adjustment for eGFR, albuminuria, age, gender and conventional cardiovascular risk factors (P= 0.03 and P< 0.001, respectively). Only a few subjects with markedly reduced renal function were included. The results presented are therefore mainly valid for a population with mildly impaired renal function. CONCLUSION These data indicate that a finding of an increased hsTnT or NT-pro-BNP in subjects with chronic kidney disease stages 1/3 should be taken seriously as a prognostic marker for a worse cardiovascular outcome and not be discarded as merely a reflection of decreased renal clearance.
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Affiliation(s)
- Lieneke Scheven
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, PO Box 30.001 AA53, 9700 RB, Groningen, The Netherlands
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Jasra SK, Badian C, Macri I, Ra P. Recognition of Early Myocardial Infarction by Immunohistochemical Staining with Cardiac Troponin-I and Complement C9*. J Forensic Sci 2012; 57:1595-600. [DOI: 10.1111/j.1556-4029.2012.02172.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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18
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O'Connor CM, Fiuzat M, Lombardi C, Fujita K, Jia G, Davison BA, Cleland J, Bloomfield D, Dittrich HC, DeLucca P, Givertz MM, Mansoor G, Ponikowski P, Teerlink JR, Voors AA, Massie BM, Cotter G, Metra M. Impact of Serial Troponin Release on Outcomes in Patients With Acute Heart Failure. Circ Heart Fail 2011; 4:724-32. [DOI: 10.1161/circheartfailure.111.961581] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Christopher M. O'Connor
- From the Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (C.M.O., M.F.); the Department of Experimental and Applied Medicine, University of Brescia, Brescia, Italy (C.L., M.M.); Merck Research Laboratories, Rahway, NJ (K.F., G.J., D.B., H.D., P.D., G.M.); Momentum Research (B.D., G.C.), Durham, NC; University of Hull, United Kingdom (J.C.); Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.G.); Medical University, Clinical Military Hospital, Wroclaw,
| | - Mona Fiuzat
- From the Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (C.M.O., M.F.); the Department of Experimental and Applied Medicine, University of Brescia, Brescia, Italy (C.L., M.M.); Merck Research Laboratories, Rahway, NJ (K.F., G.J., D.B., H.D., P.D., G.M.); Momentum Research (B.D., G.C.), Durham, NC; University of Hull, United Kingdom (J.C.); Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.G.); Medical University, Clinical Military Hospital, Wroclaw,
| | - Carlo Lombardi
- From the Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (C.M.O., M.F.); the Department of Experimental and Applied Medicine, University of Brescia, Brescia, Italy (C.L., M.M.); Merck Research Laboratories, Rahway, NJ (K.F., G.J., D.B., H.D., P.D., G.M.); Momentum Research (B.D., G.C.), Durham, NC; University of Hull, United Kingdom (J.C.); Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.G.); Medical University, Clinical Military Hospital, Wroclaw,
| | - Kenji Fujita
- From the Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (C.M.O., M.F.); the Department of Experimental and Applied Medicine, University of Brescia, Brescia, Italy (C.L., M.M.); Merck Research Laboratories, Rahway, NJ (K.F., G.J., D.B., H.D., P.D., G.M.); Momentum Research (B.D., G.C.), Durham, NC; University of Hull, United Kingdom (J.C.); Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.G.); Medical University, Clinical Military Hospital, Wroclaw,
| | - Gang Jia
- From the Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (C.M.O., M.F.); the Department of Experimental and Applied Medicine, University of Brescia, Brescia, Italy (C.L., M.M.); Merck Research Laboratories, Rahway, NJ (K.F., G.J., D.B., H.D., P.D., G.M.); Momentum Research (B.D., G.C.), Durham, NC; University of Hull, United Kingdom (J.C.); Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.G.); Medical University, Clinical Military Hospital, Wroclaw,
| | - Beth A. Davison
- From the Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (C.M.O., M.F.); the Department of Experimental and Applied Medicine, University of Brescia, Brescia, Italy (C.L., M.M.); Merck Research Laboratories, Rahway, NJ (K.F., G.J., D.B., H.D., P.D., G.M.); Momentum Research (B.D., G.C.), Durham, NC; University of Hull, United Kingdom (J.C.); Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.G.); Medical University, Clinical Military Hospital, Wroclaw,
| | - John Cleland
- From the Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (C.M.O., M.F.); the Department of Experimental and Applied Medicine, University of Brescia, Brescia, Italy (C.L., M.M.); Merck Research Laboratories, Rahway, NJ (K.F., G.J., D.B., H.D., P.D., G.M.); Momentum Research (B.D., G.C.), Durham, NC; University of Hull, United Kingdom (J.C.); Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.G.); Medical University, Clinical Military Hospital, Wroclaw,
| | - Daniel Bloomfield
- From the Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (C.M.O., M.F.); the Department of Experimental and Applied Medicine, University of Brescia, Brescia, Italy (C.L., M.M.); Merck Research Laboratories, Rahway, NJ (K.F., G.J., D.B., H.D., P.D., G.M.); Momentum Research (B.D., G.C.), Durham, NC; University of Hull, United Kingdom (J.C.); Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.G.); Medical University, Clinical Military Hospital, Wroclaw,
| | - Howard C. Dittrich
- From the Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (C.M.O., M.F.); the Department of Experimental and Applied Medicine, University of Brescia, Brescia, Italy (C.L., M.M.); Merck Research Laboratories, Rahway, NJ (K.F., G.J., D.B., H.D., P.D., G.M.); Momentum Research (B.D., G.C.), Durham, NC; University of Hull, United Kingdom (J.C.); Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.G.); Medical University, Clinical Military Hospital, Wroclaw,
| | - Paul DeLucca
- From the Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (C.M.O., M.F.); the Department of Experimental and Applied Medicine, University of Brescia, Brescia, Italy (C.L., M.M.); Merck Research Laboratories, Rahway, NJ (K.F., G.J., D.B., H.D., P.D., G.M.); Momentum Research (B.D., G.C.), Durham, NC; University of Hull, United Kingdom (J.C.); Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.G.); Medical University, Clinical Military Hospital, Wroclaw,
| | - Michael M. Givertz
- From the Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (C.M.O., M.F.); the Department of Experimental and Applied Medicine, University of Brescia, Brescia, Italy (C.L., M.M.); Merck Research Laboratories, Rahway, NJ (K.F., G.J., D.B., H.D., P.D., G.M.); Momentum Research (B.D., G.C.), Durham, NC; University of Hull, United Kingdom (J.C.); Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.G.); Medical University, Clinical Military Hospital, Wroclaw,
| | - George Mansoor
- From the Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (C.M.O., M.F.); the Department of Experimental and Applied Medicine, University of Brescia, Brescia, Italy (C.L., M.M.); Merck Research Laboratories, Rahway, NJ (K.F., G.J., D.B., H.D., P.D., G.M.); Momentum Research (B.D., G.C.), Durham, NC; University of Hull, United Kingdom (J.C.); Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.G.); Medical University, Clinical Military Hospital, Wroclaw,
| | - Piotr Ponikowski
- From the Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (C.M.O., M.F.); the Department of Experimental and Applied Medicine, University of Brescia, Brescia, Italy (C.L., M.M.); Merck Research Laboratories, Rahway, NJ (K.F., G.J., D.B., H.D., P.D., G.M.); Momentum Research (B.D., G.C.), Durham, NC; University of Hull, United Kingdom (J.C.); Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.G.); Medical University, Clinical Military Hospital, Wroclaw,
| | - John R. Teerlink
- From the Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (C.M.O., M.F.); the Department of Experimental and Applied Medicine, University of Brescia, Brescia, Italy (C.L., M.M.); Merck Research Laboratories, Rahway, NJ (K.F., G.J., D.B., H.D., P.D., G.M.); Momentum Research (B.D., G.C.), Durham, NC; University of Hull, United Kingdom (J.C.); Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.G.); Medical University, Clinical Military Hospital, Wroclaw,
| | - Adriaan A. Voors
- From the Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (C.M.O., M.F.); the Department of Experimental and Applied Medicine, University of Brescia, Brescia, Italy (C.L., M.M.); Merck Research Laboratories, Rahway, NJ (K.F., G.J., D.B., H.D., P.D., G.M.); Momentum Research (B.D., G.C.), Durham, NC; University of Hull, United Kingdom (J.C.); Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.G.); Medical University, Clinical Military Hospital, Wroclaw,
| | - Barry M. Massie
- From the Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (C.M.O., M.F.); the Department of Experimental and Applied Medicine, University of Brescia, Brescia, Italy (C.L., M.M.); Merck Research Laboratories, Rahway, NJ (K.F., G.J., D.B., H.D., P.D., G.M.); Momentum Research (B.D., G.C.), Durham, NC; University of Hull, United Kingdom (J.C.); Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.G.); Medical University, Clinical Military Hospital, Wroclaw,
| | - Gad Cotter
- From the Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (C.M.O., M.F.); the Department of Experimental and Applied Medicine, University of Brescia, Brescia, Italy (C.L., M.M.); Merck Research Laboratories, Rahway, NJ (K.F., G.J., D.B., H.D., P.D., G.M.); Momentum Research (B.D., G.C.), Durham, NC; University of Hull, United Kingdom (J.C.); Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.G.); Medical University, Clinical Military Hospital, Wroclaw,
| | - Marco Metra
- From the Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (C.M.O., M.F.); the Department of Experimental and Applied Medicine, University of Brescia, Brescia, Italy (C.L., M.M.); Merck Research Laboratories, Rahway, NJ (K.F., G.J., D.B., H.D., P.D., G.M.); Momentum Research (B.D., G.C.), Durham, NC; University of Hull, United Kingdom (J.C.); Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.G.); Medical University, Clinical Military Hospital, Wroclaw,
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Trafny DJ, Oyama MA, Wormser C, Reynolds CA, Singletary GE, Peddle GD. Cardiac troponin-I concentrations in dogs with bradyarrhythmias before and after artificial pacing. J Vet Cardiol 2010; 12:183-90. [PMID: 21030328 DOI: 10.1016/j.jvc.2010.07.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2010] [Revised: 07/22/2010] [Accepted: 07/23/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To quantify cardiac troponin-I (cTnI) concentration in dogs with symptomatic bradyarrhythmias before and after artificial pacing and to correlate cTnI concentration with diagnosis, echocardiographic parameters, serology, and outcome. ANIMALS, MATERIALS AND METHODS Medical records from the University of Pennsylvania from 2006 to 2009 were reviewed, and 14 dogs with cTnI assay results before and after pacemaker were identified. The ECG diagnosis included complete atrioventricular block (AVB), sick sinus syndrome, 2nd degree AVB, and atrial standstill. Serology, presence of premature beats, echocardiographic measurements, and pacing modality were recorded. RESULTS Mean cTnI concentration was elevated both pre- and post-pacing, and was significantly higher pre-pacing vs. post-pacing. Post-pacing cTnI concentration in 9 of 14 dogs (64%) remained above the reference range. Four dogs yielded high serum titers for Bartonella spp. Four dogs with markedly increased cTnI concentration had progressive left ventricular enlargement and myocardial failure as compared to pre-pacing examination. CONCLUSIONS Elevated cTnI concentration suggests that cardiac injury persists after artificial pacing in dogs with bradyarrhythmias. Myocarditis secondary to Bartonella spp. or other causes may be an important cause of AVB in dogs. Prospective studies investigating the correlation of cTnI to potential etiology and development of post-pacing LV dysfunction and outcome are needed.
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Affiliation(s)
- Dennis J Trafny
- Department of Clinical Studies-Philadelphia, School of Veterinary Medicine, University of Pennsylvania, MJR-VHUP-Cardiology, 3900 Delancey St., Philadelphia, PA 19104, United States
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20
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Troponin elevation in heart failure prevalence, mechanisms, and clinical implications. J Am Coll Cardiol 2010; 56:1071-8. [PMID: 20863950 DOI: 10.1016/j.jacc.2010.06.016] [Citation(s) in RCA: 353] [Impact Index Per Article: 25.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2010] [Accepted: 06/29/2010] [Indexed: 02/08/2023]
Abstract
Circulating biomarkers have become increasingly important in diagnosing and risk stratifying patients with heart failure (HF). While the natriuretic peptides have received much focus, there is increasing interest in the role of circulating cardiac troponin (cTn) in detecting myocardial injury (often subclinical) in those with HF. Accumulating evidence suggests that patients with chronic and acute HF may have measurable levels of circulating cTn, whose detection and magnitude may have prognostic implications. Furthermore, as new, more sensitive cTn assays are being developed, larger numbers of HF patients are found to have detectable cTn with a persistent relationship between magnitude and outcome. This knowledge improves our ability to understand the mechanism of worsening HF, improve risk stratification, and detect potential injury related to new therapeutics in HF. As investigators begin to understand the relationship of detectable cTn to HF outcomes, as well as temporal changes in its magnitude, and its relationship to other circulating biomarkers, more insight may be gained into the progressive nature of cardiac dysfunction and the transition from chronic compensated to acute decompensated HF. Ultimately, this information might allow physicians to guide therapy, choose appropriate therapeutics, and improve HF outcomes.
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21
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Wayangankar SA, Dasari TW, Lozano PM, Beckman KJ. A case of critical aortic stenosis masquerading as acute coronary syndrome. Cardiol Res Pract 2010; 2010. [PMID: 20721272 PMCID: PMC2913510 DOI: 10.4061/2010/423465] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2010] [Revised: 05/27/2010] [Accepted: 06/22/2010] [Indexed: 11/26/2022] Open
Abstract
Serum cardiac troponins I and T are reliable and highly specific markers of myocardial injury. Studies have shown that at least 20% of patients with severe aortic stenosis have detectable serum troponins. This case report describes a patient who presented as suspected acute coronary syndrome with markedly elevated troponin levels, who was later found to have normal coronaries and critical aortic stenosis. This case highlights the need for comprehensive and accurate physical examination in patients who present with angina. Critical aortic stenosis may cause such severe subendocardial ischemia as to cause marked elevation in cardiac markers and mimic an acute coronary syndrome. Careful physical examination will lead to an earlier use of non invasive techniques, such as echocardiography to confirm the correct diagnosis and the avoidance of inappropriate treatments such as intravenous nitroglycerin and glycoprotein IIb/IIIa inhibitors.
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Affiliation(s)
- Siddharth A Wayangankar
- Department Internal Medicine, University of Oklahoma Health Sciences Center, 920 Stanton L. Young Blvd., WP 1130, Oklahoma City, OK 73104-5020, USA
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22
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Taskapan MC, Taskapan H, Ulutas O, Orhan M, Sahin I. Relationships between Brain Natriuretic Peptide, Troponin I and QT Dispersion in Asymptomatic Dialysis Patients. Ren Fail 2009; 29:221-5. [PMID: 17365940 DOI: 10.1080/08860220601098953] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVES The relationships between increased wall stress, myocyte death, and ventricular repolarization instability in patients with heart failure were reported. DESIGN AND METHODS The relationships between brain natriuretic peptide (BNP), a predictor of increased wall stress of hearth; troponin I (cTnI), a predictor of myocyte death; and QT dispersion (QTd), a reflection of ventricular repolarization instability were evaluated in age- and sex-matched asymptomatic 29 hemodialysis (HD) patients and 26 peritoneal dialysis (PD) patients, and the finding were compared. RESULTS Serum BNP and cTnI levels in HD patients (722.9 +/- 907.9 pg/mL, 0.05 +/- 0.07 microg/L, respectively), just before HD, were significantly higher than those of PD patients (255.4 +/- 463.7 pg/mL, 0.02 +/- 0.02 microg/L, respectively; p < 0.05). There was no significant difference between groups with regard to corrected QTd and maximum and minimum QT intervals (p > 0.05). Serum cTnI levels were significantly and positively correlated with serum BNP levels in both dialysis groups (r = 0.447, p = 0.048). No relationship was found between plasma BNP and ECG parameters studied in both groups (p > 0.05). CONCLUSION Increased serum cTnI levels were associated with elevated BNP levels in both dialysis groups. The increases in BNP and troponin I are more likely to reflect hypervolemia. Although CAPD patients were receiving dialysis daily and HD patients were more hypervolemic, CAPD patients have similar QTdc and accordingly a similar tendency toward arrhythmias. This suggests that factors other than electromechanical interaction may be important in determining the QT interval length in patients on dialysis.
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Affiliation(s)
- M Cagatay Taskapan
- Biochemistry Department, Turgut Ozal Medical Center of Inonu University Medical Faculty, Malatya, Turkey.
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23
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Peacock WF, De Marco T, Fonarow GC, Diercks D, Wynne J, Apple FS, Wu AHB. Cardiac troponin and outcome in acute heart failure. N Engl J Med 2008; 358:2117-26. [PMID: 18480204 DOI: 10.1056/nejmoa0706824] [Citation(s) in RCA: 549] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Cardiac troponin provides diagnostic and prognostic information in acute coronary syndromes, but its role in acute decompensated heart failure is unclear. The purpose of our study was to describe the association between elevated cardiac troponin levels and adverse events in hospitalized patients with acute decompensated heart failure. METHODS We analyzed hospitalizations for acute decompensated heart failure between October 2001 and January 2004 that were recorded in the Acute Decompensated Heart Failure National Registry (ADHERE). Entry criteria included a troponin level that was obtained at the time of hospitalization in patients with a serum creatinine level of less than 2.0 mg per deciliter (177 micromol per liter). A positive troponin test was defined as a cardiac troponin I level of 1.0 microg per liter or higher or a cardiac troponin T level of 0.1 microg per liter or higher. RESULTS Troponin was measured at the time of admission in 84,872 of 105,388 patients (80.5%) who were hospitalized for acute decompensated heart failure. Of these patients, 67,924 had a creatinine level of less than 2.0 mg per deciliter. Cardiac troponin I was measured in 61,379 patients, and cardiac troponin T in 7880 patients (both proteins were measured in 1335 patients). Overall, 4240 patients (6.2%) were positive for troponin. Patients who were positive for troponin had lower systolic blood pressure on admission, a lower ejection fraction, and higher in-hospital mortality (8.0% vs. 2.7%, P<0.001) than those who were negative for troponin. The adjusted odds ratio for death in the group of patients with a positive troponin test was 2.55 (95% confidence interval, 2.24 to 2.89; P<0.001 by the Wald test). CONCLUSIONS In patients with acute decompensated heart failure, a positive cardiac troponin test is associated with higher in-hospital mortality, independently of other predictive variables. (ClinicalTrials.gov number, NCT00366639 [ClinicalTrials.gov].).
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Affiliation(s)
- W Frank Peacock
- Department of Emergency Medicine, Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
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24
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Parenti N, Bartolacci S, Carle F, Angelo F. Cardiac troponin I as prognostic marker in heart failure patients discharged from emergency department. Intern Emerg Med 2008; 3:43-7. [PMID: 18273567 DOI: 10.1007/s11739-008-0092-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2006] [Accepted: 09/19/2007] [Indexed: 11/27/2022]
Abstract
Despite evidence that cardiac troponin I (cTnI) identifies patients with advanced heart failure (HF) at risk of death, data on heterogeneous HF populations are scarce. Our purpose was to verify and analyze the prognostic role of cTnI in acute HF patients admitted to the emergency department. This was an observational longitudinal prospective study carried out in an urban hospital. We studied 99 patients discharged from the department between March and December 2002 with a HF diagnosis and samples of cTnI. Patients with acute coronary syndromes, myocarditis or renal failure were excluded. The main outcome was death from any cause. The detection level of the cTnI assay was 0.05 ng/ml. cTnI was detected in 45.5% of HF patients. These patients had a higher NYHA class (P<0.001) at initial presentation and longer hospitalization (P=0.004) than cTnI-negative patients. Nineteen deaths occurred during the study: 17 for HF and 2 for acute coronary syndrome. Finally, detectable cTnI was associated with increased mortality risk (RR 4.7; 95% CI 1.3-17.1; P=0.021) also after adjustment for other adverse prognosis factors (age, NYHA class and presence of relapses). Our HF cTnI-positive patients had a worse clinical presentation and longer hospitalization. cTnI is a significant independent predictor of death and of longer hospitalization. It could be used for the early identification of HF patients at an increased risk of death in the long term, and of longer hospitalization. Thus, cTnI can aid decision-making and clinical management in the emergency department.
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Affiliation(s)
- Nicola Parenti
- Department of Emergency Medicine, Community Hospital Maurizio Bufalini, Cesena, Italy.
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25
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Fonarow GC, Peacock WF, Horwich TB, Phillips CO, Givertz MM, Lopatin M, Wynne J. Usefulness of B-type natriuretic peptide and cardiac troponin levels to predict in-hospital mortality from ADHERE. Am J Cardiol 2008; 101:231-7. [PMID: 18178412 DOI: 10.1016/j.amjcard.2007.07.066] [Citation(s) in RCA: 121] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2007] [Revised: 07/20/2007] [Accepted: 07/20/2007] [Indexed: 11/18/2022]
Abstract
B-type natriuretic peptide (BNP) and cardiac troponin (Tn) I or T have been demonstrated to provide prognostic information in patients with acute coronary syndromes. Whether admission BNP and Tn levels provide additive prognostic value in acutely decompensated heart failure (HF) has not been well studied. Hospitalizations for HF from April 2003 to December 2004 entered into ADHERE were analyzed. BNP assessment on admission was performed in 48,629 (63%) of 77,467 hospitalization episodes. Tn assessment was performed in 42,636 (88%) of these episodes. In-hospital mortality was assessed using logistic regression models adjusted for age, gender, blood urea nitrogen, systolic blood pressure, creatinine, sodium, pulse, and dyspnea at rest. Median BNP was 840 pg/ml (interquartile range 430 to 1,730). Tn was increased in 2,370 (5.6%) of 42,636 HF episodes. BNP above the median and increased Tn were associated with significantly increased risk of in-hospital mortality (odds ratios [OR] 2.09 and 2.41 respectively, each p value <0.0001). Mortality was 10.2% in patients with BNP >or=840/Tn increased compared with 2.2% with BNP <840/Tn not increased (OR 5.10, p <0.0001). After covariate adjustment, mortality risk remained significantly increased with BNP >or=840/Tn not increased (adjusted OR 1.56, 95% confidence interval 1.40 to 1.79, p <0.0001), BNP <840/Tn increased (adjusted OR 1.69, 95% confidence interval 1.17 to 2.45, p = 0.006), and BNP >or=840/Tn increased (adjusted OR 3.00, 95% confidence interval 2.47 to 3.66, p <0.0001). Admission BNP and cardiac Tn levels are significant, independent predictors of in-hospital mortality in acutely decompensated HF. Patients with BNP levels >or=840 pg/ml and increased Tn levels are at particularly high risk for mortality. In conclusion, a multimarker strategy for the assessment of patients hospitalized with HF adds incremental prognostic information.
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Affiliation(s)
- Gregg C Fonarow
- Ahmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles Medical Center, Los Angeles, California, USA.
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Sribhen K, Viriyataveekul R, Wannasilp N. Biochemical detection of myocardial damage in scleroderma. Clin Chim Acta 2007; 389:193-4. [PMID: 18155668 DOI: 10.1016/j.cca.2007.11.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2007] [Revised: 11/28/2007] [Accepted: 11/28/2007] [Indexed: 11/19/2022]
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Demir M, Kanadaşı M, Akpınar O, Dönmez Y, Avkaroğulları M, Alhan C, İnal T, Şan M, Usal A, Demirtaş M. Cardiac Troponin T as a Prognostic Marker in Patients With Heart Failure : A 3-Year Outcome Study. Angiology 2007; 58:603-9. [DOI: 10.1177/0003319707307344] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Cardiac troponin T (cTnT), a highly sensitive and specific indicator of myocardial cell death, may be elevated in congestive heart failure (CHF). The aims of this study were to test the hypothesis that decompensated CHF may be associated with an increase in cTnT release and to correlate between cTnT levels and patient outcomes. The authors studied 55 patients aged between 38 and 86 years (30 women and 25 men) who were hospitalized for CHF. Left ventricular ejection fraction (EF) was calculated by using modified Simpson's rule by echocardiography. cTnT levels were assessed. Troponin T ≥0.1 ng/mL was considered as positive. All patients were contacted by phone annually during the next 3 years, and their history of subsequent hospital admissions and current health status were recorded. cTnT was negative in 44 (80%) and positive in 11 (20%) patients. EF was significantly lower and NYHA was higher in cTnT-positive patients. During the 3-year follow-up period, 25 patients died from CHF. The mortality rate was 8/11 (72.7%) among cTnT-positive patients, whereas the mortality rate was 17/44 (38.6%) among cTnT-negative patients. There were significant relationships among positivity of cTnT, NYHA, EF, and mortality rate. Multivariate regression analysis yielded an independent relationship between positivity of cTnT, NYHA classification, and mortality rate. The percent of hospital admissions due to CHF was also higher in patients with cTnT positive (63.6% versus, 27.3%, p <0.05). In conclusion, this study shows that cTnT positivity is an independent risk factor in predicting the long-term mortality and morbidity rate in patients with CHF. Patients with worsening CHF may possibly be identified early on the basis of their elevated serum cTnT levels.
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Affiliation(s)
- Mesut Demir
- Department of Cardiology, Cukurova University, School of Medicine, Adana, Turkey,
| | - Mehmet Kanadaşı
- Department of Cardiology, Cukurova University, School of Medicine, Adana, Turkey
| | - Onur Akpınar
- Department of Cardiology, Cukurova University, School of Medicine, Adana, Turkey
| | - Yurdaer Dönmez
- Department of Cardiology, Cukurova University, School of Medicine, Adana, Turkey
| | - Mahir Avkaroğulları
- Department of Cardiology, Cukurova University, School of Medicine, Adana, Turkey
| | - Cumhur Alhan
- Department of Cardiology, Cukurova University, School of Medicine, Adana, Turkey
| | - Tamer İnal
- Department of Biochemistry, Çukurova University, School of Medicine, Adana, Turkey
| | - Mustafa Şan
- Department of Cardiology, Cukurova University, School of Medicine, Adana, Turkey
| | - Ayhan Usal
- Department of Cardiology, Cukurova University, School of Medicine, Adana, Turkey
| | - Mustafa Demirtaş
- Department of Cardiology, Cukurova University, School of Medicine, Adana, Turkey
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Linklater AKJ, Lichtenberger MK, Thamm DH, Tilley L, Kirby R. Serum concentrations of cardiac troponin I and cardiac troponin T in dogs with class IV congestive heart failure due to mitral valve disease. J Vet Emerg Crit Care (San Antonio) 2007. [DOI: 10.1111/j.1476-4431.2007.00241.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Kahveci G, Bayrak F, Mutlu B, Bitigen A, Karaahmet T, Sonmez K, Izgi A, Degertekin M, Basaran Y. Prognostic value of N-terminal pro-B-type natriuretic peptide in patients with active infective endocarditis. Am J Cardiol 2007; 99:1429-33. [PMID: 17493474 DOI: 10.1016/j.amjcard.2006.12.071] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2006] [Revised: 12/21/2006] [Accepted: 12/21/2006] [Indexed: 10/23/2022]
Abstract
Our aim was to determine whether N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) and cardiac troponin I (cTnI) levels are valuable for predicting prognosis in patients with infective endocarditis (IE). We analyzed measured plasma NT-pro-BNP levels at admission in 45 patients with definite IE. The primary end point was early surgery or in-hospital death. The other data recorded were baseline clinical, echocardiographic, and laboratory parameters. Thirty patients underwent early surgery, and 9 died in hospital. Univariate analysis revealed that log NT-pro-BNP, cTnI > or =0.03 ng/ml, New York Heart Association functional class III to IV symptoms, left atrial diameter, left ventricular end-diastolic diameter, left ventricular end-systolic diameter, and severe valvular regurgitation were associated with increased risk of reaching the primary end point. Cox proportional hazard regression analysis identified log NT-pro-BNP (hazard ratio 1.5; 95% confidence interval 1.2 to 1.9, p <0.001) as the only independent predictor of the primary end point. The log NT-pro-BNP cut-off value with the highest sensitivity (97%) and specificity (92%) for predicting primary end point was 7.2 (1,500 pg/ml). Patients with NT-pro-BNP level > or =1,500 pg/ml had significantly lower event-free survival than others. In conclusion, admission NT-pro-BNP is of prognostic value in patients with IE. The combination of admission NT-pro-BNP and cTnI levels appears to have even greater value for risk stratification in this patient group.
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Affiliation(s)
- Gokhan Kahveci
- Department of Cardiology, Kosuyolu Heart and Research Hospital, Istanbul, Turkey
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30
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Glauser J, Erickson J, Bhatt D, Lindsell C, Gibler B, Hoekstra J, Pollack C, Hollander J, Peacock WF. Elevated Serum Cardiac Markers Predict Coronary Artery Disease in Patients With a History of Heart Failure Who Present With Chest Pain: Insights From the i*trACS Registry. ACTA ACUST UNITED AC 2007; 13:142-8. [PMID: 17541309 DOI: 10.1111/j.1527-5299.2007.06149.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The significance of a history of heart failure (HF) in patients presenting with acute coronary syndromes and elevated cardiac markers is unclear. The authors performed an analysis of patients enrolled in the Internet Tracking Registry of Acute Coronary Syndromes (i*trACS). Cardiac marker measurement and cardiac catheterization were performed in 1174 patients. Of these, 116 (9.9%) had heart failure (HF). Coronary artery disease (CAD) was found in 61 (52.6%) patients in the HF group and 581 (54.9%) in the group without HF. In the non-HF cohort, positive markers occurred in 306 patients, in whom 217 (70.9%) had CAD at catheterization. In the HF subset, 24 patients had positive biomarkers and 15 (62.5%) had CAD. A history of HF did not lessen the likelihood of CAD as evidenced by angiography and does not diminish the utility of cardiac markers in diagnosing acute coronary syndromes.
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Affiliation(s)
- Jonathan Glauser
- Division of Medicine, Department of Emergency Medicine, Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
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31
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Macin SM, Perna ER, Cimbaro Canella JP, Augier N, Riera Stival JL, Cialzeta J, Pitzus AE, Obregon R, Garcia E, Medina F, Badaracco RJ. Increased levels of cardiac troponin-T in outpatients with heart failure and preserved systolic function are related to adverse clinical findings and outcome. Coron Artery Dis 2006; 17:685-91. [PMID: 17119377 DOI: 10.1097/01.mca.0000236287.56435.14] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The implications of increased levels of cardiac troponin T in congestive heart failure with preserved systolic function have been poorly evaluated. We hypothesized that its presence might be related to disease severity and prognosis in this setting. METHODS Clinical, echocardiographic, 6-min walking test and laboratory data were prospectively obtained in 69 congestive heart failure outpatients with ejection fraction > or = 40%. Serial blood samples were assayed for cardiac troponin T with a third-generation immunoassay and values > or = 0.02 ng/ml were considered abnormal. RESULTS Abnormal cardiac troponin T levels in at least one sample were found in 27 patients (39%, group 1). These patients were older (71.7 +/- 11 vs. 63 +/- 12.4 years, P = 0.002); more frequently hospitalized during the previous year (63 vs. 26.2%, P = 0.003), had lower systolic blood pressure (129.3 +/- 19.6 vs. 140.4 +/- 23.5 mmHg, P = 0.04), but had similar proportion of ischemic etiology (55.6 vs. 42.9%, P = 0.21) than those with normal cardiac troponin T (group 2). In groups 1 and 2, the functional class was 2.8 +/- 0.8 and 2.1 +/- 0.9 (P = 0.03), and the distance covered in 6 min was 339 +/- 100 and 386 +/- 103 m (P = 0.05), respectively. In groups 1 and 2, the 18-month congestive heart failure hospitalization-free survival was 22 and 87%, respectively (log-rank test P = 0.0003). In a Cox-proportional hazard model, functional class III-IV (hazard ratio = 5.21, 95% confidence interval: 1.43-18.96) and myocardial injury (hazard ratio = 5.51, confidence interval: 1.58-19.24) were independently associated with prognosis. CONCLUSION Increased levels of cardiac troponin T were detected in one out of three congestive heart failure outpatients with preserved systolic function and correlated with clinical measures of disease severity and poor outcome. These findings suggest a link between ongoing myocardial injury and progressive impairment in congestive heart failure despite preserved systolic function.
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Affiliation(s)
- Stella M Macin
- Heart Failure Clinic, Instituto de Cardiologia J.F. Cabral, Corrientes, Argentina.
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de Virginy DRB. Novel and potential future biomarkers for assessment of the severity and prognosis of chronic heart failure. Heart Fail Rev 2006; 11:333-4. [PMID: 17131079 DOI: 10.1007/s10741-006-0234-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Over the last two decades, the pathophysiology and biomolecular basis of heart failure syndrome has reached sound and more comprehensive understanding. This knowledge has allowed expert researchers and clinicians to explore an entirely new spectrum of potential biochemical markers derived from different cellular and signaling pathways that lead to myocardial hypertrophy, chronic damage of the myocyte, apoptosis, and, ultimately, myocardial remodeling. Indeed, the link between myocardial remodeling and adverse outcomes, as well as the recognition of the myocardial interstitium as a multifunctional dynamic entity strongly influenced by systemic neurohormonal and inflammatory activation, has provided a solid ground for research of biomarkers that might correlate with severity and prognostication in chronic heart failure. This paper reviews and summarize recent literature on some of the most interesting circulating biomarkers with potential use for the stratification of patients with chronic heart failure.
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Affiliation(s)
- David R Buvat de Virginy
- Department of Internal Medicine, St. John's Clinic, 1100 West 10th Street, Suite 270, Rolla, Missouri 65401, USA.
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Yilmaz A, Yalta K, Turgut OO, Yilmaz MB, Ozyol A, Kendirlioglu O, Karadas F, Tandogan I. Clinical importance of elevated CK-MB and troponin I levels in congestive heart failure. Adv Ther 2006; 23:1060-7. [PMID: 17276973 DOI: 10.1007/bf02850226] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Myocyte necrosis has been considered to play a fundamental role in the pathophysiology of congestive heart failure (CHF), which has usually evolved as a consequence of depletion of compensatory mechanisms and contractile reserve of myocardium. Elevated levels of creatine kinase MB (CK-MB) and troponin I (Tn-I) have been regarded as biochemical markers of myocyte necrosis. This study was planned to investigate the specificity and sensitivity of Tn-I and CK-MB in CHF and to examine the correlation of these markers with disease severity. A total of 104 patients (38 female, 66 male; mean age, 66 y [range, 36-89]) with symptoms and signs of heart failure on admission and with a reduced left ventricular ejection fraction (EF; by transthoracic echocardiography) were labeled "the patient group," and 58 patients (40 female,18 male; mean age, 61 y [range, 34-77]) with no signs or symptoms of CHF and with a normal EF detected by transthoracic echocardiography were included in the study as "the control group." Left ventricular EFs, end-diastolic diameters, and end-systolic diameters of patients in both groups were measured. Blood samples were drawn from all patients in both groups on admission, so that levels of CK-MB and Tn-I could be measured. All patients in both groups also underwent coronary angiography. Conditions leading to elevation of CK-MB or Tn-I were considered exclusion criteria. The 2 groups failed to show any significant differences in terms of mean age and the presence of coronary artery disease, hypertension, or diabetes mellitus (P>.05). Mean EF in the patient group was lower than that in the control group (P<.05). Mean CK-MB and Tn-I in the patient group were significantly higher than in the control group (P<.05). In the patient group, hypertensive patients were found to have significantly higher mean values of CK-MB than were seen in normotensive patients in the same group (P<.05). In the patient group, 52 cases were considered to be class I-II (New York Heart Association [NYHA]) (group 1), and 52 were considered to be class III-IV (group 2). Group 1, group 2, and the control group did not differ significantly from one another with regard to the presence of coronary artery disease, hypertension, and diabetes mellitus (P>.05). The mean EF in group 2 was significantly lower than that in group 1 and in the control group (P<.05); the mean EF in group 1 was significantly lower than that in the control group (P<.05). Group 1 values did not differ significantly from those of group 2 or the control group in terms of enzymatic markers (P>.05), but group 2 had significantly higher mean values of CK-MB and Tn-I than were noted in the control group (P<.05). The uphill course of CK-MB and Tn-I values from the control group to group 2 (NYHA class III-IV) was statistically significant (P<.05). Serum concentrations of CK-MB and Tn-I may become elevated in severely symptomatic patients with CHF (particularly NYHA class III-IV), demonstrating a relationship between clinical severity of the disease and elevation of myocardial enzymes (CK-MB and Tn-I).
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Affiliation(s)
- Ahmet Yilmaz
- Department of Cardiology, Cumhuriyet University, Sivas, Turkey
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Nellessen U, Goder S, Schobre R, Abawi M, Hecker H, Tschöke S. Serial analysis of troponin I levels in patients with ischemic and nonischemic dilated cardiomyopathy. Clin Cardiol 2006; 29:219-24. [PMID: 16739395 PMCID: PMC6654721 DOI: 10.1002/clc.4960290510] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Ongoing myocardial cell damage forms the basis for progression of chronic heart failure. Evidence is accumulating that progressive loss of cardiac myocytes is associated with the release of cardiac troponin I (cTnI). HYPOTHESIS This study sought to determine whether levels of cTnI are of prognostic value for risk stratification of patients with chronic heart failure. METHODS Release of cTnI was measured by conventional enzyme immunoassay following serum ultrafiltration in 58 consecutive patients hospitalized for chronic heart failure and 31 healthy volunteers serving as control group. Determination of serum levels was performed every 2 weeks over a time interval of 3 months. According to the results of coronary angiography, patients were divided into Group D showing normal coronary arteries (n=33, ejection fraction 27 +/- 6.1%) and Group I showing severe coronary heart disease (n=25, ejection fraction 28.8 +/- 7.8%). Survival of patients was evaluated after a mean time interval of 3 years. RESULTS The mean cTnI serum level over all measurements was 0.66 +/- 1.8 ng/ml in patients versus 0.11 +/- 0.48 ng/ml in volunteers. At all six points of analysis, the mean cTnI serum level was significantly different (p < 0.001) between patients and volunteers. There was no significant difference between patients with and without coronary heart disease following hospital discharge, however, troponin release was significantly different between survivors and nonsurvivors (n=27) (0.56 ng/ml vs. 0.84 ng/ml; p < 0.05). CONCLUSION Permanent cTnI release is a common finding in patients with chronic heart failure and a strong prognosticator. In this setting, coronary morphology seems to play a minor role for disease progression.
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Affiliation(s)
- Ulrich Nellessen
- Johanniter-Krankenhaus Genthin-Stendal GmbH, Department of Cardiology, Stendal, Germany.
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Skulec R, Belohlavek J, Kovarnik T, Kolar J, Gandalovicova J, Dytrych V, Linhart A, Aschermann M. Serum cardiac markers response to biphasic and monophasic electrical cardioversion for supraventricular tachyarrhythmia—a randomised study. Resuscitation 2006; 70:423-31. [PMID: 16901614 DOI: 10.1016/j.resuscitation.2006.02.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2005] [Revised: 01/16/2006] [Accepted: 02/01/2006] [Indexed: 11/19/2022]
Abstract
BACKGROUND Electrical cardioversion in patients with various types of supraventricular tachyarrhythmia (SVT) may induce serum cardiac markers elevation. Only a few studies have evaluated the impact of the type of shock waveform on electrical myocardial injury. The aim of our study was to compare the response of serum cardiac markers to biphasic and monophasic cardioversion for SVT. METHODS One hundred and forty one patients with various SVTs referred for electrical cardioversion were randomised to monophasic (MP) or biphasic (BP) cardioversion. Serum levels of creatine kinase (CK), MB fraction of CK (CK-MB), myoglobin and troponin I were analysed before cardioversion and 254+/-58 min after the procedure. RESULTS Average age of the patients was 67.9+/-11.3 years, 71 underwent BP and 70 MP cardioversion. In MP group, cumulative energy (CE)>150J was associated with significant elevation of CK and myoglobin levels after cardioversion (1.52+/-3.81 microkat/l and 187+/-433 microg/l), while CE<150J was not (-0.04+/-0.34 and 4+/-11, p<0.05). In BP group, CE>150J was associated with significant but smaller CK elevation (0.27+/-1.09 microkat/l, p<0.05) and comparable myoglobin elevation (80.7+/-21.4 microg/l, p<0.05). CE>150J was the only independent positive predictor for CK and myoglobin elevation in both groups. No significant changes in CK-MB and Troponin I levels after cardioversion were identified. CONCLUSIONS According to our study, electrical cardioversion for SVTs is not associated with biochemical signs of myocardial injury. Application of CE>150J can be followed by CK and myoglobin elevation most likely due to skeletal muscle damage. This reaction is more pronounced in MP than in BP cardioversion.
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Affiliation(s)
- Roman Skulec
- 2nd Department of Internal Cardiovascular Medicine, General Teaching Hospital, U Nemocnice 2, 128 08 Prague 2, Czech Republic.
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Wang AYM, Lam CWK, Yu CM, Wang M, Chan IHS, Lui SF, Sanderson JE. Troponin T, left ventricular mass, and function are excellent predictors of cardiovascular congestion in peritoneal dialysis. Kidney Int 2006; 70:444-52. [PMID: 16871255 DOI: 10.1038/sj.ki.5001605] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Patients on maintenance peritoneal dialysis (PD) are frequently complicated with volume overload. In this study, we sought to evaluate troponin T testing alone or in combination with echocardiographic measures in predicting cardiovascular congestion in PD patients. This was a prospective study of 222 chronic PD patients with echocardiography and measurement of serum troponin T carried out at baseline. Patients were followed for 3 years or until death. The end point was first episode of cardiovascular congestion. Troponin T emerged as an independent predictor of cardiovascular congestion (hazard ratio, 2.98, 95% confidence intervals (CI), 1.19-7.42) in a multivariable Cox regression model, including also left ventricular mass index (LVMi) and ejection fraction (EF). Patients with troponin T>median (0.06 microg/l) and EF<or=50% and patients with troponin T>median but EF>50% had a 3.10-fold (95% CI, 1.71-5.63) and 1.88-fold (95% CI, 1.05-3.38) adjusted risk of cardiovascular congestion, respectively, than those with troponin T<or=median and EF>50%. Patients with troponin T>median and LVMi>or=median (96.23 g/m2.7) had a 2.68-fold (95% CI, 1.39-5.19) adjusted risk of cardiovascular congestion than those with troponin T<or=median and LVMi <median. In conclusion, troponin T predicts cardiovascular congestion in chronic PD patients without acute myocardial ischemia and provides incremental prognostic value for cardiovascular congestion when used in combination with LVM and EF. This easily available parameter adds significant value to echocardiography in identifying PD patients at risk of cardiovascular congestion.
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MESH Headings
- Adult
- Aged
- Biomarkers/blood
- Echocardiography
- Female
- Follow-Up Studies
- Heart Diseases/blood
- Heart Diseases/diagnostic imaging
- Heart Diseases/epidemiology
- Heart Failure/blood
- Heart Failure/diagnostic imaging
- Heart Failure/epidemiology
- Humans
- Hypertrophy, Left Ventricular/blood
- Hypertrophy, Left Ventricular/diagnostic imaging
- Hypertrophy, Left Ventricular/epidemiology
- Kidney Failure, Chronic/epidemiology
- Kidney Failure, Chronic/therapy
- Male
- Middle Aged
- Peritoneal Dialysis, Continuous Ambulatory/adverse effects
- Predictive Value of Tests
- Prognosis
- Proportional Hazards Models
- Prospective Studies
- Risk Factors
- Troponin T/blood
- Ventricular Dysfunction, Left/blood
- Ventricular Dysfunction, Left/diagnostic imaging
- Ventricular Dysfunction, Left/epidemiology
- Ventricular Function, Left
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Affiliation(s)
- A Y-M Wang
- Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong.
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Pruvot S, Galidie G, Bergmann JF, Mahé I. La troponine et les autres marqueurs de souffrance myocardique, quelle signification en médecine interne ? Rev Med Interne 2006; 27:215-26. [PMID: 16337716 DOI: 10.1016/j.revmed.2005.09.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2005] [Accepted: 09/28/2005] [Indexed: 10/25/2022]
Abstract
PURPOSE Troponin is now the gold standard for the diagnosis of myocardial infarction. Aiming at improving the management of a patient suspect of an acute coronary syndrome, this article will point the interpretation of troponin dosages according to the clinical presentation and concomitant diseases. ACTUALITIES First, the interest of troponin dosage as compared with other markers of myocardial ischemia will be underlined. Then, the literature available about troponin in cardiovascular diseases but also in extracardiac diseases will be analysed. Finally, the difficulties of assay will be discussed. PERSPECTIVES The availability of a sensitive and specific marker such as troponin is definitively a progress in the management of patients with an acute coronary syndromes. But it remains a biological contribution to the global management of the patient. It is important to know the causes susceptible to increase the levels of troponin to avoid a wrong interpretation of the dosage, leading to diagnostic but also therapeutic mistakes.
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Affiliation(s)
- S Pruvot
- Service de Médecine A, Hôpital Lariboisière, Paris, France
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Mehra MR. Optimizing outcomes in the patient with acute decompensated heart failure. Am Heart J 2006; 151:571-9. [PMID: 16504617 DOI: 10.1016/j.ahj.2005.04.034] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2004] [Accepted: 04/29/2005] [Indexed: 11/26/2022]
Abstract
Heart failure (HF) and episodes of acute decompensated HF (ADHF) continue to pose a substantial clinical challenge in the United States and represent a significant source of morbidity, mortality, and health care resource use. Recent therapeutic advances have shifted ADHF treatment paradigms from diuretic management with or without inotrope use to therapy where intravenous vasodilators are the central component, above a background of diuretics. This shift in treatment has resulted in more rapid symptomatic improvements as well as in decreases in overall morbidity and mortality. Elevated left ventricular filling pressure has become an important clinical target for resolution during ADHF, as this parameter most closely correlates with degree of symptoms, extent of ischemic complications, and the deleterious neurohormonal activation in response to ADHF. Therapies that lead to rapid improvements in left ventricular filling pressure, including the use of nesiritide, a recombinant analog of B-type natriuretic peptide, have been shown to provide rapid symptomatic relief, but effects on long-term morbidity and mortality are as yet unclear. In addition to new treatments, new technologies--including assays based on cardiac biomarkers and techniques such as impedance cardiography for noninvasive monitoring of hemodynamic parameters--are contributing to improvements in care that will ultimately reduce the sizeable clinical and economic burden that HF represents.
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Affiliation(s)
- Mandeep R Mehra
- Division of Cardiology, Department of Medicine, University of Maryland, Baltimore, MD, USA.
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Zethelius B, Johnston N, Venge P. Troponin I as a predictor of coronary heart disease and mortality in 70-year-old men: a community-based cohort study. Circulation 2006; 113:1071-8. [PMID: 16490824 DOI: 10.1161/circulationaha.105.570762] [Citation(s) in RCA: 218] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Cardiac troponin I (cTnI), a standard for detection of myocardial damage, has recently been reported to predict acute myocardial infarction or death in patients with unstable coronary heart disease (CHD). Cardiac TnI concentrations increase with age in subjects free from clinical signs of CHD, suggesting silent myocardial damage. We investigated the association between cTnI and future CHD and mortality in a community-based cohort of men. METHODS AND RESULTS A community-based study was conducted from August 1991 to May 1995 among 1203 men in Uppsala, Sweden, aged 70 years at baseline with a follow-up of up to 10.4 years with the use of registry data (National Board of Health and Welfare, Sweden). CHD was defined with the use of data taken from the Cause of Death Registry or from first-time hospitalization for CHD as recorded in the Hospital Discharge Registry. Cardiac TnI concentrations were measured blinded for outcome, in frozen baseline plasma samples, with the use of the AccuTnI from Beckman Coulter, Inc. Hazard ratios (HRs) from Cox proportional hazards are presented with 95% confidence intervals (CIs) for a 1-SD increase. In men free from cardiovascular disease (CVD), cTnI predicted death (HR, 1.26; 95% CI, 1.08 to 1.46; P=0.003) or first CHD event (HR, 1.31; 95% CI, 1.11 to 1.54; P=0.001) after adjustment for conventional risk factors: total and HDL cholesterol, plasma glucose, body mass index, smoking, and systolic blood pressure. CONCLUSIONS In this first longitudinal report, cTnI was shown to predict death and first CHD event in men free from CVD at baseline, indicating the importance of silent cardiac damage in the development of CHD and mortality.
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Affiliation(s)
- Björn Zethelius
- Department of Public Health and Caring Sciences/Geriatrics, University of Uppsala, Uppsala, Sweden.
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Abstract
Heart failure (HF) is a clinical syndrome that occurs when the ability of the heart to meet the requirements of the body fails. Myocardial infarction (MI) is a common antecedent event that predisposes a patient to HF. Loss of cardiac function following MI occurs in the context of myocyte death and ventricular remodeling. The clinical significance of HF following MI is underscored by the fact that among MI survivors, the risk of death is markedly elevated in those who develop HF compared with those who do not. Various modifying factors associated with the development of HF following MI have been identified. Use of multimodality therapy with improved clinical outcomes for HF has increased the need to specifically identify the failing heart at an earlier stage. The ability to identify heart failure early in its pathogenesis will enable finer risk stratification following MI. This article reviews various risk predictors for the development of HF following MI.
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Affiliation(s)
- Nandan S Anavekar
- Clinical Pharmacology & Therapeutics, University of Melbourne, Austin Health, Studley Road, Heidelberg 3084, Australia
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41
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Abstract
Elevated cardiac troponin concentrations are now accepted as the gold standard biochemical markers for the diagnosis of myocardial damage in patients with unstable coronary syndromes, having also a demonstrated value in early risk stratification and in adopting different therapeutic strategies. The specificity and sensitivity of cardiac troponins for diagnosis of acute coronary diseases in renal failure have been a point of confusion over the past decade, mainly because of moderate elevations of these cardiac biomarkers, commonly observed in patients with chronic renal dysfunction and without any significant myocardial damage. This review discusses the cardiac troponins, their biochemistry, their currently accepted cut-off values and their real significance in chronic renal failure (CRF), concluding that troponins maintain their diagnostic and prognostic values in patients with CRF, being predictive not only of cardiovascular mortality but also of general mortality in this patient group.
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Affiliation(s)
- I Buhaescu
- Dialysis and Renal Transplantation Center, Parhon University Hospital, Iasi, Romania.
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Gheorghiade M, Gattis Stough W, Adams KF, Jaffe AS, Hasselblad V, O'Connor CM. The Pilot Randomized Study of Nesiritide Versus Dobutamine in Heart Failure (PRESERVD-HF). Am J Cardiol 2005; 96:18G-25G. [PMID: 16181819 DOI: 10.1016/j.amjcard.2005.07.017] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Acute heart failure syndromes (AHFS) are related to several diseases affecting not only the heart but also the kidneys and blood vessels. Emerging evidence indicates that myocardial injury may also play a role in the pathophysiology of AHFS, as suggested by increased levels of markers of injury, such as cardiac troponin (cTn). Although cTn is a known prognostic marker, the release of cTn during hospitalization has not been evaluated prospectively with serial measures. We prospectively evaluated patterns of cTn release by conducting serial measures of cTnI and cTnT in patients hospitalized for AHFS. This study enrolled 51 patients with AHFS who were admitted with worsening heart failure (HF) and a history of coronary artery disease (CAD) in whom an acute coronary event was not suspected. Levels of cTnI and cTnT were measured at 8, 32, 56, and 80 hours after study entry. At baseline, 73.9% of patients had detectable cTnI, and 43.5% had detectable cTnT levels. The median concentrations of cTnI and cTnT were unchanged from 0 to 32 hours, increased from 32 to 56 hours, then either plateaued (cTnT) or decreased to baseline (cTnI). Of the 26 patients who had no detectable cTn levels at baseline, 2 (7.7%) developed detectable cTnT and 5 (41.7%) developed detectable cTnI release during hospitalization. Detectable levels of cTn at baseline were related to short-term clinical events. In this study of patients with CAD in whom an acute coronary event was not suspected, most had detectable levels of cTn present at admission, and some patients developed cTn release during hospitalization. Because cTn release may be a marker for myocardial injury, this study raises the possibility that injury occurred in most patients admitted with AHFS. Therefore, the goal of therapy for AHFS should be not only to improve symptoms and hemodynamics but also to salvage myocardium. Accordingly, therapies for AHFS that are aimed at improving hemodynamics may affect long-term prognosis by either injuring or salvaging myocardium.
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Affiliation(s)
- Mihai Gheorghiade
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA.
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Affiliation(s)
- Mihai Gheorghiade
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA.
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Abstract
OBJECTIVE Degeneration and death of cardiomyocytes contribute to the genesis of heart failure (HF) in aortic valve stenosis (AS). We studied whether the ongoing myocyte damage in AS can be detected from circulating cardiac troponin I (cTnI) concentrations. DESIGN AND SETTING A cross-sectional cohort study in a university hospital. SUBJECTS AND METHODS We examined 131 adult patients undergoing echocardiography and cardiac catheterization for isolated AS. Blood was sampled from the aortic root and, in a subset of 49 patients, also from the coronary sinus for the determination of cTnI using a sensitive immunoanalysis. RESULTS Seventy-three patients (56%) had detectable aortic cTnI (> or =5 ng L(-1)) with 30 of them (23% of the total group) having cTnI above the reference limit in healthy subjects (>14 ng L(-1)). Patients with detectable cTnI had a higher prevalence of HF than those with undetectable cTnI (42% vs. 19%, P = 0.004). Plasma cTnI rose from the aorta to the coronary sinus by > or =5 ng L(-1) in 13 of 49 patients with AS (27%) versus in none of 12 control patients free of structural heart disease (P = 0.044). AS patients with transcardiac cTnI gradients > or =5 ng L(-1) had lower left ventricular (LV) ejection fractions than AS patients with gradients <5 ng L(-1) (mean +/- SD, 52 +/- 14% vs. 61 +/- 11%; P = 0.011). CONCLUSIONS Detectable circulating cTnI is not uncommon in AS and shows a moderate association with the presence of HF. Leakage of cTnI into the coronary sinus associates with impairment of LV systolic function. Monitoring cTnI could provide a means to expose incipient clinical deterioration in AS.
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Affiliation(s)
- M Kupari
- Division of Cardiology, Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland.
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O'Connor CM, Stough WG, Gallup DS, Hasselblad V, Gheorghiade M. Demographics, clinical characteristics, and outcomes of patients hospitalized for decompensated heart failure: observations from the IMPACT-HF registry. J Card Fail 2005; 11:200-5. [PMID: 15812748 DOI: 10.1016/j.cardfail.2004.08.160] [Citation(s) in RCA: 194] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Hospitalizations for decompensated heart failure are frequent. The Initiation Management Pre-discharge Assessment of Carvedilol Heart Failure (IMPACT-HF) registry collected observational data in patients hospitalized for worsening heart failure to characterize an unselected group of patients and to confirm the generalizability of the IMPACT-HF main trial population. METHODS AND RESULTS The IMPACT-HF registry was conducted concurrently with the IMPACT-HF study, a randomized trial of in-hospital initiation of carvedilol compared with the standard practice of postdischarge beta-blocker initiation. Patients were eligible for registry enrollment if they were hospitalized for heart failure regardless of ejection fraction. There were no exclusions to participation. Patients were followed for 60 days. The IMPACT-HF Registry enrolled 567 patients. The mean age was 71 years, 52% of the patients were men and 82% were Caucasian. At discharge, 71% received an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker, 41% received digoxin, and 62% received beta-blockers. The 60-day rate of rehospitalization or death was 31%. CONCLUSION The IMPACT-HF registry enrolled elderly patients admitted for worsening heart failure primarily resulting from progressive volume overload. The 60-day rate of death or rehospitalization was high despite the use of evidence-based therapies. New treatments for this population are needed to decrease the morbidity and mortality associated with decompensated heart failure.
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Affiliation(s)
- Christopher M O'Connor
- Department of Medicine, Division of Cardiology, Duke University Medical Center and Clinical Research Institute, 2400 N. Pratt Street, Durham, NC 27705, USA
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Spratt DP, Mellanby RJ, Drury N, Archer J. Cardiac troponin I: evaluation of a biomarker for the diagnosis of heart disease in the dog. J Small Anim Pract 2005; 46:139-45. [PMID: 15789809 DOI: 10.1111/j.1748-5827.2005.tb00304.x] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To assess the value of measuring blood levels of the myocardial protein cardiac troponin I (cTnl) in the diagnosis of congenital and acquired heart disease in the dog and in the evaluation of the severity of heart failure. METHODS Serum samples obtained from healthy dogs (n = 26) and from dogs diagnosed with a variety of congenital and acquired heart conditions (n = 35) were assayed for cTnl concentration using an automated immunoassay method. Results were also analysed according to the degree of heart failure as assessed using the International Small Animal Cardiac Health Council's scheme. RESULTS Healthy dogs had very low or undetectable blood cTnl levels, as did dogs with congenital heart disease. However, cTnl levels were significantly elevated in dogs with acquired mitral valve disease, dilated cardiomyopathy and pericardial effusion. Blood cTnl levels also varied with severity of heart failure. CLINICAL SIGNIFICANCE Measurement of blood cTnl levels may be a useful aid in the diagnosis of dogs with suspected heart disease and in indicating the severity of heart failure.
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Affiliation(s)
- D P Spratt
- Department of Clinical Veterinary Medicine, University of Cambridge, Madingley Road, Cambridge CB3 0ES
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Perna ER, Macín SM, Cimbaro Canella JP, Alvarenga PM, Ríos NG, Pantich R, Augier N, Farías EF, Jantus E, Brizuela M, Medina F. Minor myocardial damage detected by troponin T is a powerful predictor of long-term prognosis in patients with acute decompensated heart failure. Int J Cardiol 2005; 99:253-61. [PMID: 15749184 DOI: 10.1016/j.ijcard.2004.01.017] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2003] [Revised: 12/28/2003] [Accepted: 01/08/2004] [Indexed: 10/26/2022]
Abstract
BACKGROUND The progression of chronic heart failure (CHF) is characterized by frequent exacerbation requiring hospitalization and high mortality. Clinical deterioration is triggered by many factors that could promote ongoing myocytes injury. We sought to determine whether a specific marker of cardiac injury, troponin T (cTnT), is associated with prognosis in acute decompensated heart failure (ADHF). METHODS One hundred and eighty-four consecutive patients with ADHF were enrolled in the absence of an acute coronary syndrome. A cTnT value> or =0.1 ng/ml in samples drawn at 6, 12 or 24 h after hospital admission was considered abnormal. RESULTS Increased levels of cTnT were found in 58 patients (31.5%, group 1). There were no significant differences between group 1 and patients with cTnT<0.1 ng/ml (group 2) in terms of demographic and clinical characteristics, although ischemic etiology was more prevalent in group 1 (51.7% vs. 31.7%, p=0.009). During follow-up, the mortality in groups 1 and 2 was 31% and 17.5% (p=0.038, OR=2.13, 95% CI: 1.03-4.69), respectively. The 3-year free-CHF readmission survival in group 1 and 2 was 25% and 53% (log rank test p=0.015). In a Cox proportional hazard model, poor tissue perfusion (HR=2.46, 95% CI=1.31-4.6), previous infarction (HR=1.99, 95% CI=1.02-3.9) and cTnT> or =0.1 ng/ml (HR=1.74, 95% CI=1.05-2.9) emerged as the independent predictors of long-term outcome. CONCLUSIONS One third of patients with decompensated CHF had elevated levels of cTnT. Troponin T was an independent long-term prognostic marker of morbidity and mortality and it suggests a role of biochemical risk stratification in this setting.
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Affiliation(s)
- Eduardo R Perna
- Heart Failure Clinic, Coronary Intensive Care Unit, Instituto de Cardiología "Juana F. Cabral", Bolivar 1334, Corrientes 3400, Argentina.
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Bertinchant JP, Combes N, Polge A, Fabbro-Peray P, Raczka F, Beck L, Cade S, Ledermann B. Prognostic value of cardiac troponin T in patients with both acute and chronic stable congestive heart failure: comparison with atrial natriuretic peptide, brain natriuretic peptide and plasma norepinephrine. Clin Chim Acta 2005; 352:143-53. [PMID: 15653109 DOI: 10.1016/j.cccn.2004.09.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2004] [Revised: 09/07/2004] [Accepted: 09/13/2004] [Indexed: 10/26/2022]
Abstract
BACKGROUND The prognostic value of cardiac troponin T (cTn-T) in a mixture of patients with both acute and chronic congestive heart failure (CHF), simultaneously assessed and compared with neurohormonal factors, has not yet been thoroughly evaluated. Thus, we focused on the prognostic value of cTn-T in comparison with atrial natriuretic peptide (ANP), brain natriuretic peptide (BNP) and plasma norepinephrine (PNE) in this population. METHODS Prognostic correlates of elevation of cTn-T, ANP, BNP, PNE were analyzed in 63 acute and chronic CHF patients followed up to record worsening CHF and cardiac death. RESULTS cTn-T (> or =0.03 microg/L) was found in 17.4% (11 of 63) of patients. cTn-T correlated with ANP, BNP, PNE. Acute CHF patients were more positive for cTn-T and BNP. In our cohort, neither cTn-T (> or =0.03 microg/L) nor PNE were associated with increased mortality and worsening HF in CHF patients. After adjustment, BNP was the only independent predictor of cardiac events (RR, 3.23; p=0.01). CONCLUSIONS BNP emerged as the only independent predictor of cardiac events in a mixture of patients with both acute and chronic CHF, suggesting that it is the analyte that best reflects long-term prognosis in a diverse population enrolled to mirror the "real world" situation.
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Affiliation(s)
- Jean-Pierre Bertinchant
- Department of Cardiology, University Hospital, Place Professeur Robert Debré, 30029 Nîmes Cedex 9, France.
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Abstract
The emergence of cardiac troponins has been an interesting step in the diagnosis of ACS. It has clearly helped us to better triage patients toward a more aggressive posture in performing early cardiac catheterization, and in some cases, early use of adjunctive Gp IIb/IIIa antagonists and percutaneous or surgical myocardial revascularization. However, with this step forward has come uncertainty and many cardiology consults regarding positive cardiac troponins in patients without ACS or myocardial infarction. In general, increased cardiac troponins imply a worse prognosis. This is clearly true of patients with ESRD and advanced heart failure. It is also true of patients with severe, noncardiac illnesses. In other situations, such as acute pericarditis and cardiac surgery, slightly elevated cardiac troponins do not seem to predict a worse prognosis, and can probably be disregarded. The elevation of cardiac troponins after successful percutaneous coronary interventions is not unexpected, and the level of cardiac troponin release seems to predict problems, but lively controversy persists. Last, monitoring cardiac troponins in cardiac transplant recipients and those receiving certain cardiotoxic chemotherapies may be of some diagnostic value, but clearly more experience and clinical research are needed.
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Affiliation(s)
- Gary S Francis
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, 9500 Euclid Avenue, F25, Cleveland, Ohio 44195, USA.
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