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Concentrations of Highly Sensitive Cardiac Troponin-I Predict Poor Cardiovascular Outcomes and Adverse Remodeling in Chronic Heart Failure

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Abstract

Highly sensitive troponin (hsTn) assays may predict cardiovascular (CV) events and left ventricular (LV) remodeling in patients with heart failure (HF). In this study, 99 subjects with LV systolic dysfunction (LVSD) were followed 10 ± 3 months with serial measurement of hsTnI by a novel method. hsTnI was detectable in all subjects and was above the 99th percentile of a normal population in 56.7 %. Supramedian baseline hsTnI concentration was associated with higher-risk clinical features and shorter time-to-first event (p = 0.008). Across serial measurements, more time spent ≤10.9 pg/mL was associated with a lower CV event rate after adjustment (odds ratio (OR) = 0.81; p = 0.008); rising hsTnI also predicted progressive LV remodeling. In conclusion, hsTnI detected significant myocardial necrosis in a majority of patients with chronic HF due to LVSD and when measured serially, provided independent risk information for poor CV outcomes and deleterious LV remodeling.

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Abbreviations

hsTnI:

Highly sensitive troponin I

CV:

Cardiovascular

HF:

Heart failure

LV:

Left ventricular

LVSD:

Left ventricular systolic dysfunction

PROTECT:

Pro-BNP Outpatient Tailored Chronic Heart Failure Therapy

NT-proBNP:

Amino-terminal pro-B type natriuretic peptide

TTE:

Transthoracic echocardiogram

LVEF:

Left ventricular ejection fraction

LVESVi:

Left ventricular end systolic volume index

LVEDVi:

Left ventricular end diastolic volume index

SD:

Standard deviation

IQR:

Interquartile range

NYHA:

New York Heart Association

eGFR:

Estimated glomerular filtration rate

References

  1. Thygesen, K., Alpert, J. S., Jaffe, A. S., Simoons, M. L., Chaitman, B. R., White, H. D., Joint ESCAAHAWHFTFftUDoMI, Katus, H. A., Lindahl, B., Morrow, D. A., Clemmensen, P. M., Johanson, P., Hod, H., Underwood, R., Bax, J. J., Bonow, R. O., Pinto, F., Gibbons, R. J., Fox, K. A., Atar, D., Newby, L. K., Galvani, M., Hamm, C. W., Uretsky, B. F., Steg, P. G., Wijns, W., Bassand, J. P., Menasche, P., Ravkilde, J., Ohman, E. M., Antman, E. M., Wallentin, L. C., Armstrong, P. W., Simoons, M. L., Januzzi, J. L., Nieminen, M. S., Gheorghiade, M., Filippatos, G., Luepker, R. V., Fortmann, S. P., Rosamond, W. D., Levy, D., Wood, D., Smith, S. C., Hu, D., Lopez-Sendon, J. L., Robertson, R. M., Weaver, D., Tendera, M., Bove, A. A., Parkhomenko, A. N., Vasilieva, E. J., & Mendis, S. (2012). Third universal definition of myocardial infarction. Circulation, 126(16), 2020–2035. doi:10.1161/CIR.0b013e31826e1058.

    Article  PubMed  Google Scholar 

  2. Januzzi, J. L., Jr., Filippatos, G., Nieminen, M., & Gheorghiade, M. (2012). Troponin elevation in patients with heart failure: on behalf of the third Universal Definition of Myocardial Infarction Global Task Force: Heart Failure Section. European Heart Journal, 33(18), 2265–2271. doi:10.1093/eurheartj/ehs191.

    Article  CAS  PubMed  Google Scholar 

  3. Horwich, T. B., Patel, J., MacLellan, W. R., & Fonarow, G. C. (2003). Cardiac troponin I is associated with impaired hemodynamics, progressive left ventricular dysfunction, and increased mortality rates in advanced heart failure. Circulation, 108(7), 833–838. doi:10.1161/01.CIR.0000084543.79097.34.

    Article  CAS  PubMed  Google Scholar 

  4. Wang, T. J., Wollert, K. C., Larson, M. G., Coglianese, E., McCabe, E. L., Cheng, S., Ho, J. E., Fradley, M. G., Ghorbani, A., Xanthakis, V., Kempf, T., Benjamin, E. J., Levy, D., Vasan, R. S., & Januzzi, J. L. (2012). Prognostic utility of novel biomarkers of cardiovascular stress: the Framingham Heart Study. Circulation, 126(13), 1596–1604. doi:10.1161/CIRCULATIONAHA.112.129437.

    Article  CAS  PubMed  Google Scholar 

  5. de Lemos, J. A., Drazner, M. H., Omland, T., Ayers, C. R., Khera, A., Rohatgi, A., Hashim, I., Berry, J. D., Das, S. R., Morrow, D. A., & McGuire, D. K. (2010). Association of troponin T detected with a highly sensitive assay and cardiac structure and mortality risk in the general population. JAMA, 304(22), 2503–2512. doi:10.1001/jama.2010.1768.

    Article  PubMed  Google Scholar 

  6. Egstrup, M., Schou, M., Tuxen, C. D., Kistorp, C. N., Hildebrandt, P. R., Gustafsson, F., Faber, J., Goetze, J. P., & Gustafsson, I. (2012). Prediction of outcome by highly sensitive troponin T in outpatients with chronic systolic left ventricular heart failure. The American Journal of Cardiology, 110(4), 552–557. doi:10.1016/j.amjcard.2012.04.033.

    Article  CAS  PubMed  Google Scholar 

  7. Masson, S., Anand, I., Favero, C., Barlera, S., Vago, T., Bertocchi, F., Maggioni, A. P., Tavazzi, L., Tognoni, G., Cohn, J. N., Latini, R., & Valsartan Heart Failure T, Gruppo Italiano per lo Studio della Sopravvivenza nell'Insufficienza Cardiaca-Heart Failure I. (2012). Serial measurement of cardiac troponin T using a highly sensitive assay in patients with chronic heart failure: data from 2 large randomized clinical trials. Circulation, 125(2), 280–288. doi:10.1161/CIRCULATIONAHA.111.044149.

    Article  CAS  PubMed  Google Scholar 

  8. Gaggin, H. K., Szymonifka, J., Bhardwaj, A., Belcher, A., De Berardinis, B., Motiwala, S., Wang, T. J., & Januzzi, J. L., Jr. (2014). Head-to-head comparison of serial soluble ST2, growth differentiation factor-15, and highly-sensitive troponin T measurements in patients with chronic heart failure. JACC Heart Failure, 2(1), 65–72. doi:10.1016/j.jchf.2013.10.005.

    Article  PubMed  Google Scholar 

  9. Januzzi, J. L., Jr., Rehman, S., Mohammed, A. A., Bhardwaj, A., Barajas, L., Barajas, J., Kim, H.-N., Baggish, A. L., Weiner, R. B., Chen, A. A., Marshall, J. E., Moore, S. A., Carlson, W. D., Lewis, G. D., Shin, J., Sullivan, D., Parks, K., Wang, T. J., Gregory, S., Uthamalingam, S., & Semigran, M. J. (2011). Use of amino-terminal pro-B type natriuretic peptide to guide outpatient therapy of patients with chronic left ventricular systolic dysfunction. Journal of the American College of Cardiology, 58, 1881–1889.

    Article  CAS  PubMed  Google Scholar 

  10. Bhardwaj, A., Rehman, S. U., Mohammed, A., Baggish, A. L., Moore, S. A., & Januzzi, J. L., Jr. (2010). Design and methods of the pro-B type natriuretic peptide outpatient tailored chronic heart failure therapy (PROTECT) Study. American Heart Journal, 159(4), 532–538. doi:10.1016/j.ahj.2010.01.005. e531.

    Article  CAS  PubMed  Google Scholar 

  11. Lang, R. M., Bierig, M., Devereux, R. B., Flachskampf, F. A., Foster, E., Pellikka, P. A., Picard, M. H., Roman, M. J., Seward, J., Shanewise, J. S., Solomon, S. D., Spencer, K. T., Sutton, M. S., & Stewart, W. J. (2005). Recommendations for chamber quantification: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. Journal of the American Society of Echocardiography: Official Publication of the American Society of Echocardiography, 18(12), 1440–1463. doi:10.1016/j.echo.2005.10.005.

    Article  Google Scholar 

  12. Gaggin, H. K., Truong, Q. A., Rehman, S. U., Mohammed, A. A., Bhardwaj, A., Parks, K. A., Sullivan, D. A., Chen-Tournoux, A., Moore, S. A., Richards, A. M., Troughton, R. W., Lainchbury, J. G., Weiner, R. B., Baggish, A. L., Semigran, M. J., & Januzzi, J. L., Jr. (2013). Characterization and prediction of natriuretic peptide "nonresponse" during heart failure management: results from the ProBNP Outpatient Tailored Chronic Heart Failure (PROTECT) and the NT-proBNP-Assisted Treatment to Lessen Serial Cardiac Readmissions and Death (BATTLESCARRED) study. Congestive Heart Failure, 19(3), 135–142. doi:10.1111/chf.12016.

    Article  PubMed  Google Scholar 

  13. Motiwala, S. R., Szymonifka, J., Belcher, A., Weiner, R. B., Baggish, A. L., Sluss, P., Gaggin, H. K., Bhardwaj, A., & Januzzi, J. L. (2013). Serial measurement of galectin-3 in patients with chronic heart failure: results from the ProBNP Outpatient Tailored Chronic Heart Failure Therapy (PROTECT) study. European Journal of Heart Failure, 15(10), 1157–1163. doi:10.1093/eurjhf/hft075.

    Article  CAS  PubMed  Google Scholar 

  14. Miller, W. L., Hartman, K. A., Burritt, M. F., Grill, D. E., & Jaffe, A. S. (2009). Profiles of serial changes in cardiac troponin T concentrations and outcome in ambulatory patients with chronic heart failure. Journal of the American College of Cardiology, 54(18), 1715–1721. doi:10.1016/j.jacc.2009.07.025.

    Article  CAS  PubMed  Google Scholar 

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Sources of Funding

This work was supported in part by Singulex, which had no role in data analysis or initial manuscript preparation. Dr. Motiwala was supported by the Dennis and Marilyn Barry Fellowship in Cardiology, Dr. Gaggin is supported in part by the Clark Fund for Cardiac Research Innovation, and Dr. Januzzi is supported in part by the Roman W. DeSanctis Clinical Scholar Endowment.

Disclosures

Dr. Januzzi has received grant support from Roche Diagnostics, Singulex, Critical Diagnostics, Siemens, and BRAHMS and consulting revenue from Novartis, Zensun, Amgen, Radiometer, and Boeringer Ingelheim. All other authors have no conflicts of interest to declare.

Human Subjects/Informed Consent

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. Informed consent was obtained from all patients for being included in the study.

Animal Studies

No animal studies were carried out by the authors for this article.

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Correspondence to James L. Januzzi Jr..

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Associate Editor Daniel P. Judge oversaw the review of this article

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Motiwala, S.R., Gaggin, H.K., Gandhi, P.U. et al. Concentrations of Highly Sensitive Cardiac Troponin-I Predict Poor Cardiovascular Outcomes and Adverse Remodeling in Chronic Heart Failure. J. of Cardiovasc. Trans. Res. 8, 164–172 (2015). https://doi.org/10.1007/s12265-015-9618-4

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  • DOI: https://doi.org/10.1007/s12265-015-9618-4

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