title: Prognostic significance of serial high-sensitivity troponin I measurements following acute cardiac decompensation-correlation with longer-term clinical outcomes and reverse remodelling.
abstract: BACKGROUND
  This study investigated the correlation of levels of and changes in serial high-sensitivity cardiac troponin I (hsTnI) with subsequent clinical event rates and changes in cardiac morphology and function in patients hospitalized for acutely decompensated heart failure (ADHF).
  
  
  RESULTS
  HsTnI levels were determined in 875 ADHF patients before discharge from hospital (baseline cohort) and clinical outcomes assessed after 180days. HsTnI was re-measured at 180days in 456/875 patients (follow-up cohort). Follow-up hsTnI values were grouped according to baseline hsTnI tertiles; echocardiographic changes from 0-180days and event rates from 180-540days were assessed in these subgroups. At baseline and 180-day follow-up, hsTnI levels were elevated (>0.06ng/mL) in 322/875 (37%) and 68/456 (15%) patients, respectively. At 180days, 85/875 patients (9.7%) had died (cardiovascular causes: 56/875 [6.4%]). Hazard ratios (HR) and 95% confidence intervals (CI) for all-cause and cardiovascular mortality (per two-fold hsTnI increase) were 1.2 (1.0-1.3; p=0.004) and 1.2 (1.1-1.4; p=0.001), respectively. In the follow-up cohort, 35/456 patients (7.7%) died between days 180 and 540 (cardiovascular death: 20/456, 4.4%). HsTnI was a significant predictor of cardiovascular re-hospitalization within 180-540days (HR 1.2, 95% CI 1.0-1.4; p=0.028). Patients with hsTnI in the lowest tertile at follow-up had more frequent and more pronounced reverse cardiac remodelling on echocardiography.
  
  
  CONCLUSIONS
  Elevated baseline hsTnI was common and associated with adverse clinical outcomes. Changes in hsTnI from baseline to 180-day follow-up predicted longer-term risk. Low or decreasing hsTnI was associated with better reverse cardiac remodelling and more favourable long-term outcomes. CLINICAL TRIAL REGISTRATION URL: http://www.controlled-trials.com. Unique identifier: ISRCTN23325295.
authors.affiliation: Department of Internal Medicine I, University Hospital Würzburg, Germany and; Comprehensive Heart Failure Center, University Hospital Würzburg, Germany.
authors.forename: Julia
authors.initials: J
authors.lastname: Wallenborn
authors.affiliation: Department of Internal Medicine I, University Hospital Würzburg, Germany and; Comprehensive Heart Failure Center, University Hospital Würzburg, Germany.
authors.forename: Almuth
authors.initials: A
authors.lastname: Marx
authors.affiliation: Department of Internal Medicine I, University Hospital Würzburg, Germany and; Comprehensive Heart Failure Center, University Hospital Würzburg, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Störk
authors.affiliation: Department of Internal Medicine I, University Hospital Würzburg, Germany and; Comprehensive Heart Failure Center, University Hospital Würzburg, Germany.
authors.forename: Gülmisal
authors.initials: G
authors.lastname: Güder
authors.affiliation: Department of Internal Medicine I, University Hospital Würzburg, Germany and; Comprehensive Heart Failure Center, University Hospital Würzburg, Germany.
authors.forename: Susanne
authors.initials: S
authors.lastname: Brenner
authors.affiliation: Department of Internal Medicine I, University Hospital Würzburg, Germany and; Comprehensive Heart Failure Center, University Hospital Würzburg, Germany.
authors.forename: Georg
authors.initials: G
authors.lastname: Ertl
authors.affiliation: Department of Internal Medicine I, University Hospital Würzburg, Germany and; Comprehensive Heart Failure Center, University Hospital Würzburg, Germany. Electronic address: Angermann_C@ukw.de.
authors.forename: Christiane E
authors.initials: CE
authors.lastname: Angermann
mesh_terms: D000208:Acute Disease; D000368:Aged; D015415:Biomarkers / Q000097:blood*; D002423:Cause of Death / Q000639:trends; D015150:Echocardiography, Doppler; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D006333:Heart Failure / Q000097:blood* / Q000401:mortality / Q000503:physiopathology; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D019210:Troponin I / Q000097:blood*; D020257:Ventricular Remodeling
chemical_list: D015415:Biomarkers; D019210:Troponin I
keywords: Biomarker; Heart failure; High-sensitivity troponin I; Morbidity; Mortality; Prognosis