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Hu H, Li J, Wei X, Zhang J, Wang J. Elevated level of high-sensitivity cardiac troponin I as a predictor of adverse cardiovascular events in patients with heart failure with preserved ejection fraction. Chin Med J (Engl) 2023; 136:2195-2202. [PMID: 37279378 PMCID: PMC10508375 DOI: 10.1097/cm9.0000000000002639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND The relationship between the elevation of cardiac troponin and the increase of mortality and hospitalization rate in patients with heart failure with reduced ejection fraction is clear. This study investigated the association between the extent of elevated levels of high-sensitivity cardiac troponin I (hs-cTnI) and the prognosis in heart failure with preserved ejection fraction patients. METHODS A retrospective cohort study consecutively enrolled 470 patients with heart failure with preserved ejection fraction from September 2014 to August 2017. According to the level of hs-cTnI, the patients were divided into the elevated level group (hs-cTnI >0.034 ng/mL in male and hs-cTnI >0.016 ng/mL in female) and the normal level group. All of the patients were followed up once every 6 months. Adverse cardiovascular events were cardiogenic death and heart failure hospitalization. RESULTS The mean follow-up period was 36.2 ± 7.9 months. Cardiogenic mortality (18.6% [26/140] vs. 1.5% [5/330], P <0.001) and heart failure (HF) hospitalization rate (74.3% [104/140] vs. 43.6% [144/330], P <0.001) were significantly higher in the elevated level group. The Cox regression analysis showed that the elevated level of hs-cTnI was a predictor of cardiogenic death (hazard ratio [HR]: 5.578, 95% confidence interval [CI]: 2.995-10.386, P <0.001) and HF hospitalization (HR: 3.254, 95% CI: 2.698-3.923, P <0.001). The receiver operating characteristic curve demonstrated that a sensitivity of 72.6% and specificity of 88.8% for correct prediction of adverse cardiovascular events when a level of hs-cTnI of 0.1305 ng/mL in male and a sensitivity of 70.6% and specificity of 90.2% when a level of hs-cTnI of 0.0755 ng/mL in female were used as the cut-off value. CONCLUSION Significant elevation of hs-cTnI (≥0.1305 ng/mL in male and ≥0.0755 ng/mL in female) is an effective indicator of the increased risk of cardiogenic death and HF hospitalization in heart failure with preserved ejection fraction patients.
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Affiliation(s)
- Hongyu Hu
- Department of Cardiovascular, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Jingjin Li
- Department of Cardiovascular, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Xin Wei
- Department of Cardiovascular, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Jia Zhang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Jiayu Wang
- Department of Neurocardiology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
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Jacob J, Haro A, Tost J, Rossello X, Llorens P, Herrero P, Martín-Sánchez FJ, Gil V, López-Grima ML, Millán J, Aguirre A, Garrido JM, Calvo-Rodríguez R, Pérez-Llantada E, Sánchez-Nicolás JA, Mir M, Rodríguez-Adrada E, Fuentes-De Frutos M, Roset A, Miró Ò. Short-term outcomes by chronic betablocker treatment in patients presenting to emergency departments with acute heart failure: BB-EAHFE. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2022; 11:761-771. [PMID: 36018216 DOI: 10.1093/ehjacc/zuac100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 08/06/2022] [Accepted: 08/08/2022] [Indexed: 06/15/2023]
Abstract
AIMS To evaluate the association between chronic treatment with betablockers (BB) and the severity of decompensation and short-term outcomes of patients with acute heart failure (AHF). METHODS AND RESULTS We consecutively included all patients presenting with AHF to 45 Spanish emergency departments (ED) during six different time-periods between 2007 and 2018. Patients were stratified according to whether they were on chronic treatment with BB at the time of ED consultation. Those receiving BB were compared (adjusted odds ratio-OR-with 95% confidence interval-CI-) with those not receiving BB group in terms of in-hospital and 7-day all-cause mortality, need for hospitalization, and prolonged length of stay (≥7 days). Among the 17 923 recruited patients (median age: 80 years; 56% women), 7795 (43%) were on chronic treatment with BB. Based on the MEESSI-AHF risk score, those on BB were at lower risk. In-hospital mortality was observed in 1310 patients (7.4%), 7-day mortality in 765 (4.3%), need for hospitalization in 13 428 (75.0%), and prolonged length of stay (43.3%). After adjustment for confounding, those on chronic BB were at lower risk for in-hospital all-cause mortality (OR = 0.85, 95% CI = 0.79-0.92, P < 0.001); 7-day all-cause mortality (OR = 0.77, 95% CI = 0.70-0.85, P < 0.001); need for hospitalization (OR = 0.89, 95% CI = 0.85-0.94, P < 0.001); prolonged length of stay (OR = 0.90, 95% CI = 0.86-0.94, P < 0.001). A propensity matching approach yielded consistent findings. CONCLUSION In patients presenting to ED with AHF, those on BB had better short-term outcomes than those not receiving BB.
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Affiliation(s)
- Javier Jacob
- Emergency Department, Hospital Universitari de Bellvitge, Institute of Biomedical Research of Bellvitge (IDIBELL), University of Barcelona (UB), Feixa Llarga s/n, L'Hospitalet de Llobregat 08907, Barcelona, Spain
| | - Antoni Haro
- Emergency Department, Hospital Universitari de Bellvitge, Institute of Biomedical Research of Bellvitge (IDIBELL), University of Barcelona (UB), Feixa Llarga s/n, L'Hospitalet de Llobregat 08907, Barcelona, Spain
| | - Josep Tost
- Emergency Department, Consorci Hospitalari de Terrassa, 08227 Terrassa, Barcelona, Spain
| | - Xavier Rossello
- Cardiology Department, Health Research Institute of the Balearic Islands (IdISBa), Hospital Universitari Son Espases, 07010 Palma, Spain
| | - Pere Llorens
- Emergency Department, Short Stay Unit and Hospital at Home, Hospital General de Alicante, Instituto de Investigación Sanitaria y Biómedica de Alicante (ISABIAL), Miguel Hernández University, 03010 Alicante, Spain
| | - Pablo Herrero
- Emergency Department, Hospital Central Asturias, 33011 Oviedo, Spain
| | | | - Víctor Gil
- Emergency Department, Hospital Clínic, IDIBAPS, University of Barcelona, 08036 Barcelona, Spain
| | | | - Javier Millán
- Emergency Department, Hospital Universitario La Fe, 46009 Valencia, Spain
| | - Alfons Aguirre
- Emergency Department, Hospital del Mar, 08003 Barcelona, Spain
| | | | - Rafael Calvo-Rodríguez
- Emergency Department, Hospital Reina Sofía de Córdoba, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), 14004 Córdoba, Spain
| | | | | | - María Mir
- Emergency Department, Hospital Infanta Leonor, 28031 Madrid, Spain
| | | | | | - Alex Roset
- Emergency Department, Hospital Universitari de Bellvitge, Institute of Biomedical Research of Bellvitge (IDIBELL), University of Barcelona (UB), Feixa Llarga s/n, L'Hospitalet de Llobregat 08907, Barcelona, Spain
| | - Òscar Miró
- Emergency Department, Hospital Clínic, IDIBAPS, University of Barcelona, 08036 Barcelona, Spain
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Prognostic impact of high-sensitive troponin on 30-day mortality in patients with acute heart failure and different classes of left ventricular ejection fraction. Heart Vessels 2022; 37:1195-1202. [PMID: 35034171 PMCID: PMC9142424 DOI: 10.1007/s00380-022-02026-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 01/07/2022] [Indexed: 11/25/2022]
Abstract
High-sensitive troponin T (hs-TnT) is increasingly used for prognostication in patients with acute heart failure (AHF). However, uncertainty exists whether hs-TnT shows comparable prognostic performance in patients with heart failure and different classes of left ventricular ejection fraction (LV-EF). The aim of the present study was to assess the prognostic value of hs-TnT for the prediction of 30-day mortality depending on the presence of HF with preserved ejection fraction (HFpEF), HF with mid-range LV-EF (HFmrEF) and HF with reduced LV-EF (HFrEF) in patients with acutely decompensated HF. Patients admitted to our institution due to AHF were retrospectively included. Clinical information was gathered from electronic and paper-based patient charts. Patients with myocardial infarction were excluded. A total of 847 patients were enrolled into the present study. A significant association was found between HF groups and hs-TnT (regression coefficient -0.018 for HFpEF vs. HFmrEF/HFrEF; p = 0.02). The area under the curve (AUC) of hs-TnT for the prediction of 30-mortality was significantly lower in patients with HFpEF (AUC 0.61) than those with HFmrEF (AUC 0.80; p = 0.01) and HFrEF (AUC 0.73; p = 0.04). Hs-TnT was not independently associated with 30-day outcome in the HFpEF group (OR 1.48 [95%-CI 0.89–2.46]; p = 0.13) in contrast to the HFmrEF group (OR 4.53 [95%-CI 1.85–11.1]; p < 0.001) and HFrEF group (OR 2.58 [95%-CI 1.57–4.23]; p < 0.001). Prognostic accuracy of hs-TnT in patients hospitalized for AHF regarding 30-day mortality is significantly lower in patients with HFpEF compared to those with HFmrEF and HFrEF.
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Accuracy of high-sensitive troponin depending on renal function for clinical outcome prediction in patients with acute heart failure. Heart Vessels 2021; 37:69-76. [PMID: 34152442 PMCID: PMC8732937 DOI: 10.1007/s00380-021-01890-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 06/11/2021] [Indexed: 10/25/2022]
Abstract
High-sensitive troponin T (hs-TnT) is increasingly used for clinical outcome prediction in patients with acute heart failure (AHF). However, there is an ongoing debate regarding the potential impact of renal function on the prognostic accuracy of hs-TnT in this setting. The aim of the present study was to assess the prognostic value of hs-TnT within 6 h of admission for the prediction of 30-day mortality depending on renal function in patients with AHF. Patients admitted to our institution due to AHF were retrospectively included. Clinical information was gathered from electronic and paper-based patient charts. Patients with myocardial infarction were excluded. A total of 971 patients were enrolled in the present study. A negative correlation between estimated glomerular filtration rate (eGFR) and hsTnT was identified (Pearson r = - 0.16; p < 0.001) and eGFR was the only variable to be independently associated with hsTnT. The area under the curve (AUC) of hs-TnT for the prediction of 30-mortality was significantly higher in patients with an eGFR ≥ 45 ml/min (AUC 0.74) compared to those with an eGFR < 45 ml/min (AUC 0.63; p = 0.049). Sensitivity and specificity of the Youden Index derived optimal cut-off for hs-TnT was higher in patients with an eGFR ≥ 45 ml/min (40 ng/l: sensitivity 73%, specificity 71%) compared to patients with an eGFR < 45 ml/min (55 ng/l: sensitivity 63%, specificity 62%). Prognostic accuracy of hs-TnT in patients hospitalized for AHF regarding 30-day mortality is significantly lower in patients with reduced renal function.
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Wang S, Liu K, Guan S, Cui G. Prognostic value of prealbumin, N-terminal pro-B-type natriuretic peptide, heart type fatty acid binding protein, and cardiac troponin I in elderly patients for heart failure and poor outcomes. J Int Med Res 2021; 49:300060521999742. [PMID: 34039072 PMCID: PMC8165533 DOI: 10.1177/0300060521999742] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objectives This study aimed to investigate the prognostic value of serum prealbumin, N-terminal pro-B-type natriuretic peptide (NT-proBNP), heart type fatty acid binding protein (hFABP), and cardiac troponin I (cTnI) for heart failure and cardiac death in elderly patients. Methods We studied 426 consecutive patients with New York Heart Association classes I to IV who were recruited between February 2014 and 2018. Cardiac mortality was the primary end point. Receiver operator characteristic curves were created to analyze predictive values. Results When prealbumin, NT-proBNP, hFABP, and cTnI were combined, the areas under the receiver operator characteristic curve reached 0.930 and 0.903 for heart failure and cardiac death, respectively. Prealbumin, NT-proBNP, hFABP, and cTnI levels changed differently during therapy in patients in different prognosis groups. These parameters improved in patients who did not develop major adverse cardiovascular events (MACEs), but were unchanged or deteriorated in patients with MACEs. Multivariate Cox regression analysis showed that these parameters were significant independent risk factors for MACEs and cardiac death. Conclusions Our study shows that serum prealbumin, NT-proBNP, hFABP, and cTnI levels are significant prognostic factors for elderly patients with poor cardiac function. These parameters are more accurate for prognosis when used together.
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Affiliation(s)
- Shengzhuo Wang
- Department of Cardiology, Jinchang Hospital of Integrated Traditional Chinese and Western Medicine, Jinchang, China
| | - Ketong Liu
- Department of Cardiovascular Medicine, the Second Affiliated Hospital of Qiqihar Medical College, Qiqihar, China
| | - Shoukun Guan
- Department of Cardiovascular Medicine, the Second Affiliated Hospital of Qiqihar Medical College, Qiqihar, China
| | - Ge Cui
- Department of Pathology, the Second Affiliated Hospital of Huzhou University, Huzhou, China
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Roset A, Jacob J, Herrero-Puente P, Alquézar A, Martín-Sanchez FJ, Llorens P, Gil V, Cabello I, Richard F, Garrido JM, Gil C, Llauger L, Wussler D, Mueller C, Miró Ò. High-sensitivity cardiac troponin T 30 days all-come mortality in patients with acute heart failure. A Propensity Score-Matching Analysis Based on the EAHFE Registry. TROPICA4 Study. Eur J Clin Invest 2020; 50:e13248. [PMID: 32306389 DOI: 10.1111/eci.13248] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 04/05/2020] [Accepted: 04/12/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Acute heart failure (AHF) patients with high troponin levels have a worse prognosis. High-sensitive troponin T (hs-TnT) has been used as a tool to stratify prognosis in many scales but always as a qualitative and not as a quantitative variable. OBJECTIVES The main objective of this study was to determine the best hs-TnT cut-off for prediction of 30-day all-cause mortality. METHODS The EAHFE registry, a prospective follow-up cohort of patients with AHF, was analysed. We performed a propensity score analysis of the optimal hs-TnT cut-off point previously determined by receiver operating characteristic (ROC) curve analysis. RESULTS Of the 13 791 patients in the EAHFE cohort, we analysed 3190 patients in whom hs-TnT determination was available. The area under the ROC curve for 30-day all-cause mortality was 0.70 (CI95% 0.68 to 0.71; P < .001), establishing an optimal cut-off of hs-TnT of 35 ng/L. The sensitivity and specificity of this cut-off were 76.2 and 55.5%, respectively, with a negative predictive value (NPV) of 95.3%. A propensity score was made with 34 variables showing differences based on the cut-off of 35 ng/L for hs-TnT. In the analysis of the population obtained with the propensity score, patients with hs-TnT > 35 ng/L showed a greater 30-day all-cause mortality, with a HR of 2.95 (CI95% 1.83-4.75; P < .001). External validation reported similar results. CONCLUSIONS An hs-TnT value of 35 ng/L is an adequate cut-off to evaluate the prediction of 30-day all-cause mortality with a NPV of 95.3%.
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Affiliation(s)
- Alex Roset
- Emergency Department, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Javier Jacob
- Emergency Department, Hospital Universitari de Bellvitge, Barcelona, Spain
| | | | - Aitor Alquézar
- Emergency Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Francisco Javier Martín-Sanchez
- Emergency Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Universidad Complutense de Madrid, Madrid, Spain
| | - Pere Llorens
- Department of Emergency Medicine, Short-Stay Unit and Hospital at-home, Hospital General Universitario de Alicante, Alicante, Spain
| | - Victor Gil
- Emergency Department, Hospital Clín, Research Group Emergencies: Processes and Diseases, IDIBAPS, Barcelona, Spain
| | - Irene Cabello
- Emergency Department, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Fernando Richard
- Emergency Department, Hospital Universitario de Burgos, Burgos, Spain
| | | | - Cristina Gil
- Emergency Department, Hospital Universitario de Salamanca, Salamanca, Spain
| | - Lluis Llauger
- Department of Emergency Medicine, Hospital Universitari de Vic, Barcelona, Spain
| | - Desiree Wussler
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Christian Mueller
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Òscar Miró
- Emergency Department, Hospital Clín, Research Group Emergencies: Processes and Diseases, IDIBAPS, Barcelona, Spain
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Aimo A, Januzzi JL, Mueller C, Mirò O, Pascual Figal DA, Jacob J, Herrero-Puente P, Llorens P, Wussler D, Kozhuharov N, Sabti Z, Breidthardt T, Vergaro G, Ripoli A, Prontera C, Saccaro L, Passino C, Emdin M. Admission high-sensitivity troponin T and NT-proBNP for outcome prediction in acute heart failure. Int J Cardiol 2019; 293:137-142. [DOI: 10.1016/j.ijcard.2019.06.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 05/30/2019] [Accepted: 06/03/2019] [Indexed: 01/08/2023]
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González-Del-Hoyo M, Cediel G, Carrasquer A, Bonet G, Vásquez-Nuñez K, Boqué C, Alí S, Bardají A. Prognostic implications of troponin I elevation in emergency department patients with tachyarrhythmia. Clin Cardiol 2019; 42:546-552. [PMID: 30895632 PMCID: PMC6523000 DOI: 10.1002/clc.23175] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 03/06/2019] [Accepted: 03/14/2019] [Indexed: 01/05/2023] Open
Abstract
Background Tachyarrhythmias are very common in emergency medicine, and little is known about the long‐term prognostic implications of troponin I levels in these patients. Hypothesis This study aimed to investigate the correlation of cardiac troponin I (cTnI) levels and long‐term prognosis in patients admitted to the emergency department (ED) with a primary diagnosis of tachyarrhythmia. Methods A retrospective cohort study was conducted between January 2012 and December 2013, enrolling patients admitted to the ED with a primary diagnosis of tachyarrhythmia and having documented cTnI measurements. Clinical characteristics and 5‐year all‐cause mortality were analyzed. Results Of a total of 222 subjects with a primary diagnosis of tachyarrhythmia, 73 patients had elevated levels of cTnI (32.9%). Patients with elevated cTnI levels were older and presented significantly more cardiovascular risk factors. At the 5‐year follow‐up, mortality was higher among patients with elevated cTnI levels (log‐rank test P < 0.001). In the multivariable Cox regression analysis, elevated cTnI was an independent predictor of all‐cause death (hazard ratio, 1.95, 95% confidence interval: 1.08‐3.50, P = 0.026), in addition to age and prior heart failure. Conclusion Patients admitted to the ED with a primary diagnosis of tachyarrhythmia and high cTnI levels have higher long‐term mortality rates than patients with low cTnI levels. cTnI is thus a biomarker with predictive capacity for mortality in late follow‐up, conferring utility in the risk stratification of this population.
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Affiliation(s)
- Maribel González-Del-Hoyo
- Cardiology Department, University Hospital of Tarragona Joan XXIII, IISPV, Rovira i Virgili University, Tarragona, Spain
| | - Germán Cediel
- Cardiology Department, University Hospital Germans Trias Pujol, Badalona, Spain
| | - Anna Carrasquer
- Cardiology Department, University Hospital of Tarragona Joan XXIII, IISPV, Rovira i Virgili University, Tarragona, Spain
| | - Gil Bonet
- Cardiology Department, University Hospital of Tarragona Joan XXIII, IISPV, Rovira i Virgili University, Tarragona, Spain
| | - Karla Vásquez-Nuñez
- Cardiology Department, University Hospital of Tarragona Joan XXIII, IISPV, Rovira i Virgili University, Tarragona, Spain
| | - Carme Boqué
- Emergency Service Department, University Hospital of Tarragona Joan XXIII, IISPV, Rovira i Virgili University, Tarragona, Spain
| | - Samuel Alí
- Clinical Analysis Service, University Hospital of Tarragona Joan XXIII, IISPV, Rovira i Virgili University, Tarragona, Spain
| | - Alfredo Bardají
- Cardiology Department, University Hospital of Tarragona Joan XXIII, IISPV, Rovira i Virgili University, Tarragona, Spain
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Roset A, Jacob J, Herrero-Puente P, Alquézar A, Martín-Sanchez FJ, Llorens P, Llauger L, Gil V, Miró Ò. Characteristics and prognosis of patients with acute heart failure without troponin determination: The EAHFE-TROPICA3 study. Arch Cardiovasc Dis 2019; 112:390-399. [PMID: 31014989 DOI: 10.1016/j.acvd.2019.02.004] [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: 11/18/2018] [Revised: 01/08/2019] [Accepted: 02/19/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND The absence of cardiac troponin (cTn) determination in an episode of acute heart failure (AHF) is frequent. The characteristics of these patients are not well known; nor is it known whether they have a better prognosis than patients in whom cTn is determined. AIM The objective of the EAHFE-TROPICA3 study was to analyse the characteristics of patients consulting for AHF in whom cTn was not determined (nocTn), and to evaluate the relationship of cTn determination (wcTn) with patient outcomes. METHODS This was an analysis of the multipurpose prospective EAHFE registry of patients with AHF consulting at the emergency departments of 34 Spanish hospitals. RESULTS Data from 8850 patients with AHF were analysed; cTn was not determined in 4216 of these patients (47.6%), who had a lower prevalence of ischaemic heart disease, more frequent use of loop diuretics at baseline, a greater rate of oedema in the acute episode, more frequent history of heart failure, and less use of angiotensin-converting enzyme inhibitors or aldosterone receptor antagonists and beta-blockers at baseline. Compared with the wcTn group, the nocTn group had the same in-hospital mortality (adjusted odds ratio [OR] 1.21, 95% confidence interval [CI] 0.98-1.50), mortality at 30 days (adjusted OR 1.07, 95% CI 0.90-1.28) and reconsultation at 30 days (adjusted OR 0.90, 95% CI 0.80-1.02). CONCLUSIONS Patients presenting with AHF with and without cTn determination have different characteristics. These differences are not related to a better prognosis.
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Affiliation(s)
- Alex Roset
- Emergency Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, 08907 Barcelona, Catalonia, Spain
| | - Javier Jacob
- Emergency Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, 08907 Barcelona, Catalonia, Spain.
| | - Pablo Herrero-Puente
- Emergency Department, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain
| | - Aitor Alquézar
- Emergency Department, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Catalonia, Spain
| | - Francisco Javier Martín-Sanchez
- Emergency Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Pere Llorens
- Department of Emergency Medicine, Short-Stay Unit and Hospital At-Home, Hospital General Universitario de Alicante, 03010 Alicante, Spain
| | - Lluís Llauger
- Department of Emergency Medicine, Hospital Universitari de Vic, 08500 Barcelona, Catalonia, Spain
| | - Victor Gil
- Emergency Department, Hospital Clínic, Research Group "Emergencies: Processes and Pathologies", IDIBAPS, 08036 Barcelona, Catalonia, Spain
| | - Òscar Miró
- Emergency Department, Hospital Clínic, Research Group "Emergencies: Processes and Pathologies", IDIBAPS, 08036 Barcelona, Catalonia, Spain
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Miró Ò, Herrero-Puente P, Prieto B, García-García M, García-Hernández P, Martín-Sánchez FJ, Jacob J, Ríos J, Romero R, Gil V, Gayat É, Llorens P, Mebazaa A. The subset of patients with acute heart failure able to secrete relaxin-2 at pregnancy concentrations could have a longer survival: a pilot study. Biomarkers 2018; 23:573-579. [PMID: 29716428 DOI: 10.1080/1354750x.2018.1463564] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To investigate how many patients with acute heart failure (AHF) hypersecrete relaxin-2 concentrations similar to those of pregnant women and determine their long-term outcome. METHODS In consecutive AHF patients relaxin-2 was quantified by ELISA sandwich method. Patients were divided into pregnancy-like group (PLG, relaxin-2 ≥ 500 pg/mL) and control group (CG, relaxin-2 < 500 pg/mL). The primary outcome was all-cause death during follow-up. Secondary endpoints were prolonged hospitalisation (>10 days), combined endpoint (death, rehospitalisation, ED revisit) 30 days after discharge, and 30-day, one-year and three-year death rates. RESULTS We included 814 patients [81 (SD = 9) years; 53.0% women] followed during 1.9 (SD 2.8) years; 517 (63.5%) died. Twenty patients (2.5%) formed the PLG (median relaxin-2 = 1459 pg/mL; IQR = 1722) and 794 the CG (median = 26; IQR = 44). There was no interaction with variables included on adjustment (age, sex, ischaemic cardiomyopathy, NT-proBNP, glycaemia, and sodium). PLG patients did not have better short-term secondary endpoints, but did show a significantly lower three-year mortality [ORadjusted = 0.17 (0.05-0.5), p = 0.003]. CONCLUSIONS The small proportion of AHF patients achieving relaxin-2 concentrations similar to those observed in pregnancy may survive longer.
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Affiliation(s)
- Òscar Miró
- a Department of Emergency , Hospital Clínic, Barcelona; "Emergencies: processes and pathologies" Research Group, IDIBAPS, University of Barcelona , Barcelona , Catalonia , Spain.,b The Global REsearch on Acute conditions Team (GREAT) network
| | - Pablo Herrero-Puente
- c Department of Emergency , Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias (IISPA) , Oviedo , Spain
| | - Belén Prieto
- d Biochemistry Laboratory , Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias (IISPA) , Oviedo , Spain
| | - María García-García
- d Biochemistry Laboratory , Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias (IISPA) , Oviedo , Spain
| | - Pablo García-Hernández
- d Biochemistry Laboratory , Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias (IISPA) , Oviedo , Spain
| | - Francisco J Martín-Sánchez
- e Department of Emergency , Hospital Clínico San Carlos, Universidad Complutense de Madrid , Madrid , Spain
| | - Javier Jacob
- f Department of Emergency , Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat , Barcelona , Catalonia , Spain
| | - José Ríos
- g Laboratory of Biostatistics and Epidemiology , Universitat Autonoma de Barcelona; Medical Statistics Core Facility, IDIBAPS, Hospital Clinic , Barcelona , Catalonia , Spain
| | - Rodolfo Romero
- h Department of Emergency Department , Hospital de Getafe , Madrid , Spain
| | - Víctor Gil
- a Department of Emergency , Hospital Clínic, Barcelona; "Emergencies: processes and pathologies" Research Group, IDIBAPS, University of Barcelona , Barcelona , Catalonia , Spain
| | - Étienne Gayat
- b The Global REsearch on Acute conditions Team (GREAT) network.,i U942 INSERM, Department of Anesthesiology and Critical Care Medicine , Saint Louis Lariboisière University Hospital, Université Paris Diderot , Paris , France
| | - Pere Llorens
- j Department of Emergency, Home Hospitalization and Short Stay Unit , Hospital General de Alicante , Alicante , Spain
| | - Alexandre Mebazaa
- b The Global REsearch on Acute conditions Team (GREAT) network.,i U942 INSERM, Department of Anesthesiology and Critical Care Medicine , Saint Louis Lariboisière University Hospital, Université Paris Diderot , Paris , France
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