title: Serial changes in high-sensitive troponin I predict outcome in patients with decompensated heart failure.
abstract: OBJECTIVE
  The aim of this study was to evaluate the prognostic utility of small troponin I (TnI) elevations, serial TnI measurements, and the combination of TnI and brain natriuretic peptide (BNP) in patients with decompensated heart failure (HF).
  
  
  RESULTS
  One hundred and forty-four patients with acute HF were followed from admission to 90 days post-discharge. Primary endpoints were all cause mortality and HF-related readmission. Troponin I and BNP levels were checked on admission, discharge, and up to four consecutive days during hospitalization. A discharge TnI cut-off of 23.25 ng/L and discharge BNP cut-off of 360 ng/L were determined by receiver operator characteristic (ROC). Troponin I above 23.25 ng/L is associated with increased risk for mortality and readmission (P = 0.003). Comparing with TnI quartile 1, TnI quartiles 2-4 had increased mortality and readmission, P = 0.019, P = 0.007, P = 0.014, respectively. Compared with patients with low TnI+low BNP, increased mortality and readmission were seen in patients with high TnI+high BNP (P = 0.007), high TnI+low BNP (P = 0.015), and low TnI+high BNP (P = 0.042). Patients with increasing TnI during treatment had increased mortality compared with patients with stable or decreasing TnI (P = 0.047). In multivariate analysis, TnI reached statistical significance (P = 0.009), while BNP did not.
  
  
  CONCLUSIONS
  This study demonstrates that very small TnI elevations and BNP elevations are associated with increased 90-day mortality and readmission. When compared by ROC and multivariate analysis, TnI is as good a predictor of mortality and readmission as BNP if not slightly better. Patients with increasing TnI during hospitalization for acute HF had increased risk for 90-day mortality.
authors.affiliation: Department of Medicine, University of California at San Diego, 200 West Arbor Drive, San Diego, CA 92103, USA. yxue100@yahoo.com
authors.forename: Yang
authors.initials: Y
authors.lastname: Xue
authors.forename: Paul
authors.initials: P
authors.lastname: Clopton
authors.forename: William F
authors.initials: WF
authors.lastname: Peacock
authors.forename: Alan S
authors.initials: AS
authors.lastname: Maisel
mesh_terms: D000368:Aged; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood; D002140:California; D016001:Confidence Intervals; D018450:Disease Progression; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000188:drug therapy / Q000401:mortality*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D015999:Multivariate Analysis; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012372:ROC Curve; D016896:Treatment Outcome; D019210:Troponin I / Q000097:blood*
chemical_list: D015415:Biomarkers; D019210:Troponin I; D020097:Natriuretic Peptide, Brain