title: Diagnostic and Long-Term Prognostic Value of Sensitive Troponin I in Symptomatic Patients Suspected of Acute Heart Failure.
abstract: BACKGROUND
  To evaluate the diagnostic and prognostic value of sensitive troponin I (TnI) in patients with acute dyspnea and/or peripheral edema suspected of having acute heart failure (AHF).
  
  
  METHODS
  This single centre prospective clinical study evaluates 372 patients presenting with acute dyspnea and/or peripheral edema to the emergency department (ED). Measurements of TnI and NT-proBNP were performed at the initial presentation in the ED. All patients were followed up to 5 years. The diagnostic value of TnI compared to NT-proBNP for AHF diagnosis as well as long-term prognostic values for all cause mortality and AHF related rehospitalization were evaluated.
  
  
  RESULTS
  TnI plus NT-proBNP improved the diagnosis of AHF (improvement of accuracy (75%, 95% CI 71% - 79%), specificity (68%, 95% CI 62% - 74%), PPV (54%, 95% CI 47% - 62%), and NRI +0.15) compared to NT-proBNP alone (p = 0.0001). TnI levels showed independent prognostic value for all-cause mortality and AHF related rehospitalization after 1 and 5 years (range of AUCs 0.64 - 0.72; p = 0.03 or lower). Highest TnI levels of the 4th quartile revealed an up to 5.5 times higher risk of death within 1 and 5 years (range of HRs: 2.5 - 5.5; p = 0.0001). TnI added significantly to multivariable Cox prediction models even after adjusting for NT-proBNP, particularly in AHF patients (range of HRs: 2.1 - 2.7; p ≤ 0.05).
  
  
  CONCLUSIONS
  TnI improves AHF diagnosis when combined with NT-proBNP. TnI identifies patients with high 1- and 5-year all-cause mortality and AHF-related rehospitalization risk and adds prognostic value to NT-proBNP.
authors.forename: Michael
authors.initials: M
authors.lastname: Behnes
authors.forename: Florian
authors.initials: F
authors.lastname: Espeter
authors.forename: Ursula
authors.initials: U
authors.lastname: Hoffmann
authors.forename: Siegfried
authors.initials: S
authors.lastname: Lang
authors.forename: Martina
authors.initials: M
authors.lastname: Brueckmann
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Akin
authors.forename: Martin
authors.initials: M
authors.lastname: Borggrefe
authors.forename: Thomas
authors.initials: T
authors.lastname: Bertsch
authors.forename: Christel
authors.initials: C
authors.lastname: Weiss
authors.forename: Michael
authors.initials: M
authors.lastname: Neumaier
authors.forename: Parviz
authors.initials: P
authors.lastname: Ahmad-Nejad
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000175:diagnosis* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012680:Sensitivity and Specificity; D019210:Troponin I / Q000097:blood*; D055815:Young Adult
chemical_list: D019210:Troponin I