title: Use of High-Sensitivity Troponin T to Identify Patients With Acute Heart Failure at Lower Risk for Adverse Outcomes: An Exploratory Analysis From the RELAX-AHF Trial.
abstract: The aim of this study was to determine if a baseline high-sensitivity troponin T (hsTnT) value ≤99th percentile upper reference limit (0.014 μg/l ["low hsTnT"]) identifies patients at low risk for adverse outcomes.
  
  
  
  Approximately 85% of patients who present to emergency departments with acute heart failure are admitted. Identification of patients at low risk might decrease unnecessary admissions.
  
  
  
  A post-hoc analysis was conducted from the RELAX-AHF (Serelaxin, Recombinant Human Relaxin-2, for Treatment of Acute Heart Failure) trial, which randomized patients within 16 h of presentation who had systolic blood pressure >125 mm Hg, mild to moderate renal impairment, and N-terminal pro-brain natriuretic peptide ≥1,600 ng/l to serelaxin versus placebo. Linear regression models for continuous endpoints and Cox models for time-to-event endpoints were used.
  
  
  
  Of the 1,076 patients with available baseline hsTnT values, 107 (9.9%) had low hsTnT. No cardiovascular (CV) deaths through day 180 were observed in the low-hsTnT group compared with 79 CV deaths (7.3%) in patients with higher hsTnT. By univariate analyses, low hsTnT was associated with lower risk for all 5 primary outcomes: 1) days alive and out of the hospital by day 60; 2) CV death or rehospitalization for heart failure or renal failure by day 60; 3) length of stay; 4) worsening heart failure through day 5; and 5) CV death through day 180. After multivariate adjustment, only 180-day CV mortality remained significant (hazard ratio: 0.0; 95% confidence interval: 0.0 to 0.736; p = 0.0234; C-index = 0.838 [95% confidence interval: 0.798 to 0.878]).
  
  
  
  No CV deaths through day 180 were observed in patients with hsTnT levels ≤0.014 μg/l despite high N-terminal pro-brain natriuretic peptide levels. Low baseline hsTnT may identify patients with acute heart failure at very low risk for CV mortality.
authors.affiliation: Indiana University School of Medicine and Regenstrief Institute, Indianapolis, Indiana. Electronic address: ppang@iu.edu.
authors.forename: Peter S
authors.initials: PS
authors.lastname: Pang
authors.affiliation: University of California, San Francisco, and San Francisco Veterans Affairs Medical Center, San Francisco, California.
authors.forename: John R
authors.initials: JR
authors.lastname: Teerlink
authors.affiliation: University of Groningen, Groningen, the Netherlands.
authors.forename: Adriaan A
authors.initials: AA
authors.lastname: Voors
authors.affiliation: Medical University, Clinical Military Hospital, Wroclaw, Poland.
authors.forename: Piotr
authors.initials: P
authors.lastname: Ponikowski
authors.affiliation: University of California, San Diego, San Diego, California.
authors.forename: Barry H
authors.initials: BH
authors.lastname: Greenberg
authors.affiliation: Athens University Hospital, Attikon, Athens, Greece.
authors.forename: Gerasimos
authors.initials: G
authors.lastname: Filippatos
authors.affiliation: Duke University School of Medicine and the Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: G Michael
authors.initials: GM
authors.lastname: Felker
authors.affiliation: Momentum Research, Durham, North Carolina.
authors.forename: Beth A
authors.initials: BA
authors.lastname: Davison
authors.affiliation: Momentum Research, Durham, North Carolina.
authors.forename: Gad
authors.initials: G
authors.lastname: Cotter
authors.affiliation: Columbia University, New York, New York.
authors.forename: Joshua
authors.initials: J
authors.lastname: Kriger
authors.affiliation: Novartis Pharmaceuticals, New Hanover, New Jersey.
authors.forename: Margaret F
authors.initials: MF
authors.lastname: Prescott
authors.affiliation: Novartis Pharmaceuticals, New Hanover, New Jersey.
authors.forename: Tsushung A
authors.initials: TA
authors.lastname: Hua
authors.affiliation: Novartis Pharma, Basel, Switzerland.
authors.forename: Thomas
authors.initials: T
authors.lastname: Severin
authors.affiliation: University of Brescia, Brescia, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Metra
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000401:mortality*; D015897:Comorbidity; D004636:Emergency Service, Hospital; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000188:drug therapy / Q000453:epidemiology; D006801:Humans; D007676:Kidney Failure, Chronic / Q000453:epidemiology*; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010359:Patient Readmission / Q000706:statistics & numerical data*; D010446:Peptide Fragments / Q000097:blood; D011379:Prognosis; D016016:Proportional Hazards Models; D016032:Randomized Controlled Trials as Topic; D011994:Recombinant Proteins / Q000627:therapeutic use; D012065:Relaxin / Q000627:therapeutic use; D051437:Renal Insufficiency / Q000453:epidemiology; D018570:Risk Assessment; D016896:Treatment Outcome; D020107:Troponin T / Q000097:blood*
chemical_list: D010446:Peptide Fragments; D011994:Recombinant Proteins; D020107:Troponin T; C109794:pro-brain natriuretic peptide (1-76); C577649:serelaxin protein, human; D020097:Natriuretic Peptide, Brain; D012065:Relaxin
keywords: acute heart failure; emergency department; risk stratification; serelaxin