Recurrent low-level Troponin i elevation is a worse prognostic indicator than occasional injury pattern in patients hospitalized with heart failure

Sameer Ather, Ravi S. Hira, Maithili Shenoy, Omid Fatemi, Anita Deswal, David Aguilar, Kumudha Ramasubbu, Mariana Bolos, Wenyaw Chan, Biykem Bozkurt

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Background: Elevated troponin at baseline is associated with higher mortality in heart failure (HF) patients, but the prognostic role of recurrently elevated troponin is not well described. Methods and results: We performed chart reviews of 196 HF patients without acute coronary syndrome, with at least three Troponin I (TnI) measurements on different admissions. For the analyses, three sets of TnI values closest to baseline, one year and two years were selected for each patient. Based on the three sets of TnI, the lowest value of TnI (minimum), the highest value of TnI (maximum), median value of TnI and delta TnI (3rd TnI-baseline TnI) were derived for each patient. The study population of 196 patients had 632 person-year follow-up, consisted predominantly of elderly (68 ± 10 years) male patients (99%) with mean ejection fraction of 26 ± 13%. Using multivariate Cox proportional hazards model only minimum TnI, but not the maximum, median or delta of TnI values, was significantly associated with mortality (HR: 13.7, 95% CI: 3.7 to 50.8, p < 0.001). As a categorical variable, minimum TnI value of > 0.04 ng/ml was also independently associated with mortality (p = 0.01, HR = 1.6, 95% CI: 1.1 to 2.3). Conclusions: In HF patients without acute coronary syndrome, the persistence of TnI elevation, even at low levels, is associated with a worse survival than sporadic TnI elevations of higher magnitude or any single elevation in TnI; and a recurrent elevation of TnI > 0.04 ng/ml portends a poor prognosis.

Original languageEnglish
Pages (from-to)394-398
Number of pages5
JournalInternational Journal of Cardiology
Volume166
Issue number2
DOIs
Publication statusPublished - 20-06-2013
Externally publishedYes

Fingerprint

Troponin
Troponin I
Heart Failure
Wounds and Injuries
Acute Coronary Syndrome
Mortality
Proportional Hazards Models

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Ather, Sameer ; Hira, Ravi S. ; Shenoy, Maithili ; Fatemi, Omid ; Deswal, Anita ; Aguilar, David ; Ramasubbu, Kumudha ; Bolos, Mariana ; Chan, Wenyaw ; Bozkurt, Biykem. / Recurrent low-level Troponin i elevation is a worse prognostic indicator than occasional injury pattern in patients hospitalized with heart failure. In: International Journal of Cardiology. 2013 ; Vol. 166, No. 2. pp. 394-398.
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title = "Recurrent low-level Troponin i elevation is a worse prognostic indicator than occasional injury pattern in patients hospitalized with heart failure",
abstract = "Background: Elevated troponin at baseline is associated with higher mortality in heart failure (HF) patients, but the prognostic role of recurrently elevated troponin is not well described. Methods and results: We performed chart reviews of 196 HF patients without acute coronary syndrome, with at least three Troponin I (TnI) measurements on different admissions. For the analyses, three sets of TnI values closest to baseline, one year and two years were selected for each patient. Based on the three sets of TnI, the lowest value of TnI (minimum), the highest value of TnI (maximum), median value of TnI and delta TnI (3rd TnI-baseline TnI) were derived for each patient. The study population of 196 patients had 632 person-year follow-up, consisted predominantly of elderly (68 ± 10 years) male patients (99{\%}) with mean ejection fraction of 26 ± 13{\%}. Using multivariate Cox proportional hazards model only minimum TnI, but not the maximum, median or delta of TnI values, was significantly associated with mortality (HR: 13.7, 95{\%} CI: 3.7 to 50.8, p < 0.001). As a categorical variable, minimum TnI value of > 0.04 ng/ml was also independently associated with mortality (p = 0.01, HR = 1.6, 95{\%} CI: 1.1 to 2.3). Conclusions: In HF patients without acute coronary syndrome, the persistence of TnI elevation, even at low levels, is associated with a worse survival than sporadic TnI elevations of higher magnitude or any single elevation in TnI; and a recurrent elevation of TnI > 0.04 ng/ml portends a poor prognosis.",
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Ather, S, Hira, RS, Shenoy, M, Fatemi, O, Deswal, A, Aguilar, D, Ramasubbu, K, Bolos, M, Chan, W & Bozkurt, B 2013, 'Recurrent low-level Troponin i elevation is a worse prognostic indicator than occasional injury pattern in patients hospitalized with heart failure', International Journal of Cardiology, vol. 166, no. 2, pp. 394-398. https://doi.org/10.1016/j.ijcard.2011.10.113

Recurrent low-level Troponin i elevation is a worse prognostic indicator than occasional injury pattern in patients hospitalized with heart failure. / Ather, Sameer; Hira, Ravi S.; Shenoy, Maithili; Fatemi, Omid; Deswal, Anita; Aguilar, David; Ramasubbu, Kumudha; Bolos, Mariana; Chan, Wenyaw; Bozkurt, Biykem.

In: International Journal of Cardiology, Vol. 166, No. 2, 20.06.2013, p. 394-398.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Recurrent low-level Troponin i elevation is a worse prognostic indicator than occasional injury pattern in patients hospitalized with heart failure

AU - Ather, Sameer

AU - Hira, Ravi S.

AU - Shenoy, Maithili

AU - Fatemi, Omid

AU - Deswal, Anita

AU - Aguilar, David

AU - Ramasubbu, Kumudha

AU - Bolos, Mariana

AU - Chan, Wenyaw

AU - Bozkurt, Biykem

PY - 2013/6/20

Y1 - 2013/6/20

N2 - Background: Elevated troponin at baseline is associated with higher mortality in heart failure (HF) patients, but the prognostic role of recurrently elevated troponin is not well described. Methods and results: We performed chart reviews of 196 HF patients without acute coronary syndrome, with at least three Troponin I (TnI) measurements on different admissions. For the analyses, three sets of TnI values closest to baseline, one year and two years were selected for each patient. Based on the three sets of TnI, the lowest value of TnI (minimum), the highest value of TnI (maximum), median value of TnI and delta TnI (3rd TnI-baseline TnI) were derived for each patient. The study population of 196 patients had 632 person-year follow-up, consisted predominantly of elderly (68 ± 10 years) male patients (99%) with mean ejection fraction of 26 ± 13%. Using multivariate Cox proportional hazards model only minimum TnI, but not the maximum, median or delta of TnI values, was significantly associated with mortality (HR: 13.7, 95% CI: 3.7 to 50.8, p < 0.001). As a categorical variable, minimum TnI value of > 0.04 ng/ml was also independently associated with mortality (p = 0.01, HR = 1.6, 95% CI: 1.1 to 2.3). Conclusions: In HF patients without acute coronary syndrome, the persistence of TnI elevation, even at low levels, is associated with a worse survival than sporadic TnI elevations of higher magnitude or any single elevation in TnI; and a recurrent elevation of TnI > 0.04 ng/ml portends a poor prognosis.

AB - Background: Elevated troponin at baseline is associated with higher mortality in heart failure (HF) patients, but the prognostic role of recurrently elevated troponin is not well described. Methods and results: We performed chart reviews of 196 HF patients without acute coronary syndrome, with at least three Troponin I (TnI) measurements on different admissions. For the analyses, three sets of TnI values closest to baseline, one year and two years were selected for each patient. Based on the three sets of TnI, the lowest value of TnI (minimum), the highest value of TnI (maximum), median value of TnI and delta TnI (3rd TnI-baseline TnI) were derived for each patient. The study population of 196 patients had 632 person-year follow-up, consisted predominantly of elderly (68 ± 10 years) male patients (99%) with mean ejection fraction of 26 ± 13%. Using multivariate Cox proportional hazards model only minimum TnI, but not the maximum, median or delta of TnI values, was significantly associated with mortality (HR: 13.7, 95% CI: 3.7 to 50.8, p < 0.001). As a categorical variable, minimum TnI value of > 0.04 ng/ml was also independently associated with mortality (p = 0.01, HR = 1.6, 95% CI: 1.1 to 2.3). Conclusions: In HF patients without acute coronary syndrome, the persistence of TnI elevation, even at low levels, is associated with a worse survival than sporadic TnI elevations of higher magnitude or any single elevation in TnI; and a recurrent elevation of TnI > 0.04 ng/ml portends a poor prognosis.

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