Significance of an Early Repeat Troponin Measurement Upon Presentation to the Hospital for Acute Heart Failure - PubMed (original) (raw)

Multicenter Study

. 2024 Sep 17;13(18):e034850.

doi: 10.1161/JAHA.124.034850. Epub 2024 Sep 9.

Alan S Maisel 2, Dirk J van Veldhuisen 3, Christian Mueller 4, Christopher Hogan 5, Michael C Kontos 6, Chad M Cannon 7, Gerhard A Müller 8, Pam Taub 2, Gary M Vilke 9, Stephen Duff 10, Kenneth McDonald 11 12, Niall Mahon 11, Julio Nuñez 13 14, Carlo Briguori 15, Claudio Passino 16, Patrick T Murray 10, Nicholas Wettersten 2 17

Affiliations

Multicenter Study

Significance of an Early Repeat Troponin Measurement Upon Presentation to the Hospital for Acute Heart Failure

Yu Horiuchi et al. J Am Heart Assoc. 2024.

Abstract

Background: Higher cardiac troponin is associated with worse outcomes in patients with acute heart failure. The significance of repeat measurements over hours remains unclear. We assessed whether a repeat measurement and the Δ between measurements of high-sensitivity cardiac troponin I (hs-cTnI) were associated with outcomes in hypervolemic patients with acute heart failure without acute coronary syndrome.

Methods and results: We analyzed 582 individuals from AKINESIS (Acute Kidney Injury Neutrophil Gelatinase-Associated Lipocalin Evaluation of Symptomatic Heart Failure Study) with hs-cTnI measured ≤12 hours from admission and repeated ≤6 hours thereafter. Associations between hs-cTnI levels and their Δ with short-term (death, intensive care unit admission, receipt of inotropes, or positive pressure ventilation during hospitalization) and long-term (death or heart failure readmission within 1 year) outcomes were assessed. The average age was 69±13 years, 62% were men, 65% were White, 46% had coronary artery disease, and 22% had chest pain. Median hs-cTnI levels were 27 (interquartile range [IQR], 13-62) ng/L initially and 28 (IQR, 14-68) ng/L subsequently, with a Δ of 0 [IQR, -2 to 4] ng/L over 3.4±1 hours. Only the second measurement was associated with short-term outcomes (odds ratio, 1.14 per 2-fold higher [95% CI, 1.02-1.28]). Both individual measurements and the Δ were associated with long-term outcomes (hazard ratios, 1.09, 1.12, and 1.16 for first, second, and Δ, respectively). Associated risk for the first and second measurements were not constant over the year but highest early after being measured and decreased over 1 year.

Conclusions: Repeat measurements of hs-cTnI over hours can identify individuals with acute heart failure without acute coronary syndrome at risk for short- and long-term outcomes.

Keywords: acute heart failure; myocardial injury; prognosis; troponin.

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Figures

Figure 1

Figure 1. Association of repeat hs‐cTnI measurements and the Δ between measurements modeled as restricted cubic splines with in‐hospital events.

The median hs‐cTnI value is set as the reference for hazard ratio estimates. Risk increased in a linear fashion with higher values of the first and second hs‐cTnI measurement (A and B). Risk for the Δ between measurements was relatively flat before increasing, with higher risk in individuals with the greatest increase in hs‐cTnI (C). hs‐cTnI indicates high‐sensitivity cardiac troponin I.

Figure 2

Figure 2. Association of repeat hs‐cTnI measurements and the Δ between measurements modeled as restricted cubic splines with death or heart failure hospitalization at 1 year.

The median hs‐cTnI value is set as the reference for hazard ratio estimates. Both the first and second hs‐cTnI measurements had a sharp increase in risk from lower values to higher values until hazard ratios leveled off after the median value (A and B). Similar to the spline of odds ratio, risk for Δ hs‐cTnI was relatively flat before increasing, with higher risk in individuals with the greatest increase in hs‐cTnI (C). hs‐cTnI indicates high‐sensitivity cardiac troponin I.

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