title: Troponin I in acute decompensated heart failure: insights from the ASCEND-HF study.
abstract: OBJECTIVE
  We examined the prognostic importance of cardiac troponin I (cTnI) in a cohort of patients enrolled in the ASCEND-HF study of nesiritide in acute decompensated heart failure (ADHF). Circulating troponins are a prognostic marker in patients with ADHF. Contemporary assays with greater sensitivity require reassessment of the significance of troponin elevation in HF.
  
  
  RESULTS
  Cardiac troponin I was measured in a core laboratory in 808 ADHF patients enrolled in the ASCEND-HF biomarkers substudy using a sensitive assay (VITROS Trop I ES, Ortho Clinical Diagnostics) with a lower limit of detection of 0.012 ng/mL and a 99th percentile upper reference limit (URL) of 0.034 ng/mL. Patients with clinical evidence of acute coronary syndrome or troponin >5× the URL were excluded. Multivariable modelling was used to assess the relationship between log(cTnI) and in-hospital and post-discharge outcomes. Baseline cTnI was undetectable in 22% and elevated above the 99th percentile URL in 50% of subjects. cTnI levels did not differ based on HF aetiology. After multivariable adjustment, higher cTnI was associated with worsened in-hospital outcomes such as length of stay (P = 0.01) and worsening HF during the index hospitalization (P = 0.01), but was not associated with worsened post-discharge outcomes at 30 or 180 days. The relationship between cTnI and outcomes was generally linear and there was no evidence of a threshold effect at any particular level of cTnI.
  
  
  CONCLUSIONS
  cTnI is elevated above the 99th percentile URL in 50% of ADHF patients and predicts in-hospital outcome, but is not an independent predictor of long-term outcomes.
authors: Duke Clinical Research Institute, Duke University Medical Center, Durham, NC 27705, USA. Michael.felker@duke.edu
authors: G Michael
authors: GM
authors: Felker
authors: Vic
authors: V
authors: Hasselblad
authors: W H Wilson
authors: WH
authors: Tang
authors: Adrian F
authors: AF
authors: Hernandez
authors: Paul W
authors: PW
authors: Armstrong
authors: Gregg C
authors: GC
authors: Fonarow
authors: Adriaan A
authors: AA
authors: Voors
authors: Marco
authors: M
authors: Metra
authors: John J V
authors: JJ
authors: McMurray
authors: Javed
authors: J
authors: Butler
authors: Gretchen M
authors: GM
authors: Heizer
authors: Kenneth
authors: K
authors: Dickstein
authors: Barry M
authors: BM
authors: Massie
authors: Dan
authors: D
authors: Atar
authors: Richard W
authors: RW
authors: Troughton
authors: Stefan D
authors: SD
authors: Anker
authors: Robert M
authors: RM
authors: Califf
authors: Randall C
authors: RC
authors: Starling
authors: Christopher M
authors: CM
authors: O'Connor
mesh_terms: D000368:Aged; D016001:Confidence Intervals; D005260:Female; D006331:Heart Diseases / Q000097:blood* / Q000401:mortality / Q000473:pathology; D006801:Humans; D008297:Male; D015233:Models, Statistical; D015999:Multivariate Analysis; D045283:Natriuretic Agents / Q000097:blood*; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D016017:Odds Ratio; D011379:Prognosis; D013223:Statistics as Topic; D019210:Troponin I / Q000097:blood*
chemical_list: D045283:Natriuretic Agents; D019210:Troponin I; D020097:Natriuretic Peptide, Brain