title: Elevated troponin I level assessed by a new high-sensitive assay and the risk of poor outcomes in patients with acute heart failure.
abstract: BACKGROUND
  The interpretation and clinical usefulness of elevated levels of cardiac troponins in acute heart failure (AHF) remain controversial. We aimed to characterize the relationship between changes in cardiac troponin I (measured using a new high-sensitive immunoassay by single-molecule counting technology, Singulex, Alameda, USA; hs-TnI) during first 48h of hospital stay and patients' characteristics and the outcomes.
  
  
  RESULTS
  We measured hs-TnI at baseline, after 24 and 48h in 130 AHF patients (mean age: 65±13years, 77% men). The percentage of patients with elevated hs-TnI (i.e., above the upper reference limit [URL]>10.19pg/mL) were: on admission - 59%, after 24h - 61%, and after 48h - 58%. Elevated baseline level of hs-TnI was associated with more severe dyspnoea on admission but neither peak level nor changes in hs-TnI during first 48h were related to the dyspnoea severity or magnitude of dyspnoea relief. During 1-year follow-up there were 32 (25%) cardiovascular deaths. Neither absolute baseline nor peak values of hs-TnI predicted cardiovascular mortality. Only changes in hs-TnI were independently associated with cardiovascular mortality with the strongest relationship seen in peak change in hs-TnI: patients with an increase vs. remaining patients - hazard ratio (95% confidence interval): 3.22 (1.52-6.82)p=0.002.
  
  
  CONCLUSIONS
  Using the new assay (proved to be more sensitive that the other available troponin assays) we observed that approximately 60% of patients with AHF presented elevated hs-TnI above URL during first 48h of hospital stay. Only significant increase in hs-TnI predicted cardiovascular mortality.
authors.affiliation: Centre for Heart Diseases - Clinical Military Hospital, Wroclaw, Poland. Electronic address: robertzymlinski@gmail.com.
authors.forename: R
authors.initials: R
authors.lastname: Zymliński
authors.affiliation: Centre for Heart Diseases - Clinical Military Hospital, Wroclaw, Poland; Wroclaw Medical University, Department of Heart Diseases, Wroclaw, Poland.
authors.forename: M
authors.initials: M
authors.lastname: Sokolski
authors.affiliation: Centre for Heart Diseases - Clinical Military Hospital, Wroclaw, Poland.
authors.forename: P
authors.initials: P
authors.lastname: Siwolowski
authors.affiliation: Centre for Heart Diseases - Clinical Military Hospital, Wroclaw, Poland; Wroclaw Medical University, Department of Heart Diseases, Wroclaw, Poland.
authors.forename: J
authors.initials: J
authors.lastname: Biegus
authors.affiliation: Centre for Heart Diseases - Clinical Military Hospital, Wroclaw, Poland.
authors.forename: S
authors.initials: S
authors.lastname: Nawrocka
authors.affiliation: Centre for Heart Diseases - Clinical Military Hospital, Wroclaw, Poland; Wroclaw Medical University, Department of Heart Diseases, Wroclaw, Poland.
authors.forename: E A
authors.initials: EA
authors.lastname: Jankowska
authors.affiliation: Singulex, California Inc., 1701 Harbor Bay Parkway, Alameda, CA 94502, United States.
authors.forename: J
authors.initials: J
authors.lastname: Todd
authors.affiliation: Singulex, California Inc., 1701 Harbor Bay Parkway, Alameda, CA 94502, United States.
authors.forename: R
authors.initials: R
authors.lastname: Yerramilli
authors.affiliation: Singulex, California Inc., 1701 Harbor Bay Parkway, Alameda, CA 94502, United States.
authors.forename: J
authors.initials: J
authors.lastname: Estis
authors.affiliation: Centre for Heart Diseases - Clinical Military Hospital, Wroclaw, Poland.
authors.forename: W
authors.initials: W
authors.lastname: Banasiak
authors.affiliation: Centre for Heart Diseases - Clinical Military Hospital, Wroclaw, Poland; Wroclaw Medical University, Department of Heart Diseases, Wroclaw, Poland.
authors.forename: P
authors.initials: P
authors.lastname: Ponikowski
mesh_terms: D000208:Acute Disease; D000368:Aged; D015415:Biomarkers / Q000097:blood; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000401:mortality; D006801:Humans; D007118:Immunoassay; D008297:Male; D011044:Poland / Q000453:epidemiology; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D019210:Troponin I / Q000097:blood*
chemical_list: D015415:Biomarkers; D019210:Troponin I
keywords: Acute heart failure; High-sensitivity cardiac troponin