TY - JOUR
T1 - High-sensitivity troponin I in hospitalized and ambulatory patients with heart failure with preserved ejection fraction
T2 - Insights from the heart failure clinical research network
AU - Fudim, Marat
AU - Ambrosy, Andrew P.
AU - Sun, Jie Lena
AU - Anstrom, Kevin J.
AU - Bart, Bradley A.
AU - Butler, Javed
AU - Ezzeddine, Omar Abou
AU - Greene, Stephen J.
AU - Mentz, Robert J.
AU - Redfield, Margaret M.
AU - Reddy, Yogesh N.V.
AU - Vaduganathan, Muthiah
AU - Braunwald, Eugene
AU - Hernandez, Adrian F.
AU - Borlaug, Barry A.
AU - Felker, G. Michael
N1 - Publisher Copyright:
© 2018 The Authors.
PY - 2018/12/1
Y1 - 2018/12/1
N2 - Background-We sought to study the prevalence of high-sensitivity troponin and its association with cardiac structure and outcomes in ambulatory and hospitalized patients with heart failure with a preserved ejection fraction (HFpEF). Methods and Results-A post hoc analysis utilized data from HFpEF patients: DOSE (Diuretic Optimization Strategies Evaluation) and CARRESS-HF (Cardiorenal Rescue Study in Acute Decompensated Heart Failure) enrolled patients hospitalized with acute HFpEF, and RELAX (Phosphodiesterase-5 Inhibition to Improve Clinical Status and Exercise Capacity in Heart Failure With Preserved Ejection Fraction) enrolled ambulatory patients with HFpEF. High-sensitivity troponin I (hs-TnI) was measured in hospitalized patients at baseline, at 72 to 96 hours, on day 7, and on day 60. In ambulatory patients hs-TnI was measured at baseline and at week 24. In the ambulatory cohort, correlations between hs-TnI and cardiac structure and function were assessed. The association between hs-TnI and a 60-day composite of emergency room visits, readmissions, and death was assessed for hospitalized patients using multivariable Cox proportional hazard models. The study population included 139 hospitalized and 212 ambulatory patients with HFpEF and hs-TnI measured at baseline. The median (25th, 75th percentiles) baseline troponin was 17.6 (11.1, 41.0) ng/L in hospitalized patients and 9.5 (5.3, 19.7) ng/L in ambulatory patients (P<0.001). The prevalence of elevated hs-TnI (>99% percentile upper reference limit was 86% in hospitalized patients and 53% among ambulatory patients, with stable elevation in ambulatory patients during follow-up. HFpEF patients with a hs-TnI above the median were older with worse left ventricular hypertrophy and diastolic dysfunction. Continuously valued hs-TnI (per doubling) was associated with increased risk of composite end point (adjusted hazard ratio 1.20, 95% confidence interval 1.00-1.43; P=0.042). Conclusions-Hs-TnI is commonly elevated among both hospitalized and ambulatory patients with HFpEF. Increased hs-TnI levels are associated with worse cardiac structure and increased risk of adverse events.
AB - Background-We sought to study the prevalence of high-sensitivity troponin and its association with cardiac structure and outcomes in ambulatory and hospitalized patients with heart failure with a preserved ejection fraction (HFpEF). Methods and Results-A post hoc analysis utilized data from HFpEF patients: DOSE (Diuretic Optimization Strategies Evaluation) and CARRESS-HF (Cardiorenal Rescue Study in Acute Decompensated Heart Failure) enrolled patients hospitalized with acute HFpEF, and RELAX (Phosphodiesterase-5 Inhibition to Improve Clinical Status and Exercise Capacity in Heart Failure With Preserved Ejection Fraction) enrolled ambulatory patients with HFpEF. High-sensitivity troponin I (hs-TnI) was measured in hospitalized patients at baseline, at 72 to 96 hours, on day 7, and on day 60. In ambulatory patients hs-TnI was measured at baseline and at week 24. In the ambulatory cohort, correlations between hs-TnI and cardiac structure and function were assessed. The association between hs-TnI and a 60-day composite of emergency room visits, readmissions, and death was assessed for hospitalized patients using multivariable Cox proportional hazard models. The study population included 139 hospitalized and 212 ambulatory patients with HFpEF and hs-TnI measured at baseline. The median (25th, 75th percentiles) baseline troponin was 17.6 (11.1, 41.0) ng/L in hospitalized patients and 9.5 (5.3, 19.7) ng/L in ambulatory patients (P<0.001). The prevalence of elevated hs-TnI (>99% percentile upper reference limit was 86% in hospitalized patients and 53% among ambulatory patients, with stable elevation in ambulatory patients during follow-up. HFpEF patients with a hs-TnI above the median were older with worse left ventricular hypertrophy and diastolic dysfunction. Continuously valued hs-TnI (per doubling) was associated with increased risk of composite end point (adjusted hazard ratio 1.20, 95% confidence interval 1.00-1.43; P=0.042). Conclusions-Hs-TnI is commonly elevated among both hospitalized and ambulatory patients with HFpEF. Increased hs-TnI levels are associated with worse cardiac structure and increased risk of adverse events.
KW - Clinical outcomes
KW - Heart failure with preserved ejection fraction
KW - High-sensitivity troponin
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U2 - 10.1161/JAHA.118.010364
DO - 10.1161/JAHA.118.010364
M3 - Article
C2 - 30561266
AN - SCOPUS:85058761546
SN - 2047-9980
VL - 7
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
IS - 24
M1 - e010364
ER -