Persistently Increased Serum Concentrations of Cardiac Troponin in Patients With Acutely Decompensated Heart Failure are Predictive of Adverse Outcomes

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Background Persistently increased serum concentrations of cardiac troponin (cTn) are a prognostic marker in patients suffering from chronic congestive heart failure (CHF), but the significance in acute cardiac decompensation is unclear. Methods and Results Serial blood samples were collected from 52 patients presenting with acute cardiac de-compensation in the absence of an acute coronary event. Serial serum concentrations of cTnI, creatine kinase (CK)-MB, and brain natriuretic peptide (BNP) were measured by rapid assay. BNP and CK-MB steadily de-creased from 902±529pg/ml and 2.3±1.6ng/ml at baseline to 453±427pg/ml and 1.2±1.6ng/ml on day 7, respectively, (p<0.0001 for both comparisons). In contrast, cTnI did not decrease significantly and, in 17 patients (35%), increased from 0.063±0.047ng/ml at baseline to 0.167±0.181 ng/ml on day 1 (p<0.05). By single variable regression analysis, systolic blood pressure (SBP), use of inotropes or inodilators, vasodilators, and an initially elevated cTnI were predictors of elevated cTnI on day 1. By multiple variable analysis, an elevated SBP (as a mitigating factor) (odds ratios (OR) 0.12; 95% confidence intervals (CI): 0.02-0.76; p=0.0248), and high baseline cTnI (OR 13.85; 95%CI: 1.97-97.54; p=0.0083) were significant predictors of an elevated cTnI on day 1. Patients with elevated cTnI on day 1 had higher rates of worsening CHF and death from CHF than patients without such an increase (p<0.05). Conclusions Persistently increased serum concentrations of cTn in patients with acutely decompensated heart failure are predictive of adverse outcomes.
社団法人日本循環器学会の論文
2007-06-20

Persistently Increased Serum Concentrations of Cardiac Troponin in Patients With Acutely Decompensated Heart Failure are Predictive of Adverse Outcomes

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