文摘
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 48 h of hospital stay and patients' characteristics and the outcomes.Methods and resultsWe measured hs-TnI at baseline, after 24 and 48 h in 130 AHF patients (mean age: 65 ± 13 years, 77% men). The percentage of patients with elevated hs-TnI (i.e., above the upper reference limit [URL] > 10.19 pg/mL) were: on admission – 59%, after 24 h – 61%, and after 48 h – 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 48 h 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.ConclusionsUsing 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 48 h of hospital stay. Only significant increase in hs-TnI predicted cardiovascular mortality.
