title: Persistently increased serum concentrations of cardiac troponin in patients with acutely decompensated heart failure are predictive of adverse outcomes.
abstract: BACKGROUND
  Persistently increased serum concentrations of cardiac troponin (cTn) are a prognostic marker in patients suffering from chronic congestive heart failure (CHF), but the significance in acute cardiac decompensation is unclear.
  
  
  RESULTS
  Serial blood samples were collected from 52 patients presenting with acute cardiac decompensation in the absence of an acute coronary event. Serial serum concentrations of cTnI, creatine kinase (CK)-MB, and brain natriuretic peptide (BNP) were measured by rapid assay. BNP and CK-MB steadily decreased from 902+/-529 pg/ml and 2.3+/-1.6 ng/ml at baseline to 453+/-427 pg/ml and 1.2+/-1.6 ng/ml on day 7, respectively, (p<0.0001 for both comparisons). In contrast, cTnI did not decrease significantly and, in 17 patients (35%), increased from 0.063+/-0.047 ng/ml at baseline to 0.167+/-0.181 ng/ml on day 1 (p<0.05). By single variable regression analysis, systolic blood pressure (SBP), use of inotropes or inodilators, vasodilators, and an initially elevated cTnI were predictors of elevated cTnI on day 1. By multiple variable analysis, an elevated SBP (as a mitigating factor) (odds ratios (OR) 0.12; 95% confidence intervals (CI): 0.02-0.76; p=0.0248), and high baseline cTnI (OR 13.85; 95%CI: 1.97-97.54; p=0.0083) were significant predictors of an elevated cTnI on day 1. Patients with elevated cTnI on day 1 had higher rates of worsening CHF and death from CHF than patients without such an increase (p<0.05).
  
  
  CONCLUSIONS
  Persistently increased serum concentrations of cTn in patients with acutely decompensated heart failure are predictive of adverse outcomes.
authors.affiliation: Department of Cardiology, Hyogo Prefectural Amagasaki Hospital, Amagasaki, Japan.
authors.forename: Yasuhide
authors.initials: Y
authors.lastname: Kuwabara
authors.forename: Yukihito
authors.initials: Y
authors.lastname: Sato
authors.forename: Tadashi
authors.initials: T
authors.lastname: Miyamoto
authors.forename: Ryoji
authors.initials: R
authors.lastname: Taniguchi
authors.forename: Tatsuhiko
authors.initials: T
authors.lastname: Matsuoka
authors.forename: Kei
authors.initials: K
authors.lastname: Isoda
authors.forename: Keiichirou
authors.initials: K
authors.lastname: Yamane
authors.forename: Kiyoto
authors.initials: K
authors.lastname: Nishi
authors.forename: Hisayoshi
authors.initials: H
authors.lastname: Fujiwara
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Takatsu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D052279:Creatine Kinase, MB Form / Q000097:blood; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000175:diagnosis* / Q000473:pathology; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D032383:Myocytes, Cardiac / Q000473:pathology; D020097:Natriuretic Peptide, Brain / Q000097:blood; D011237:Predictive Value of Tests; D011379:Prognosis; D012044:Regression Analysis; D014336:Troponin / Q000097:blood*
chemical_list: D015415:Biomarkers; D014336:Troponin; D020097:Natriuretic Peptide, Brain; D052279:Creatine Kinase, MB Form