Abstract 16818: Circulating Cardiac Troponin I as Detected By a High-Sensitivity Assay among Patients Hospitalized with Acute Decompensated Heart Failure

Abstract

Background: Detectable circulating cardiac troponin (cTn) has been associated with increased risk of death or rehospitalization in patients hospitalized with acute decompensated heart failure (ADHF). Little is known about the association between cTn levels measured using high-sensitivity assays (hsTn) and outcomes. Methods: We analyzed hsTnI data from patients enrolled in DOSE - a randomized controlled trial of diuretic strategies in ADHF. hsTnI was measured at baseline at a central academic core laboratory using a high-sensitivity assay (Beckman Coulter hs-cTnI) with a lower limit of detection of 2.06 pg/mL and a 99 th percentile upper reference limit (URL) of 8.6 pg/mL. We used the Cox regression model to look for an association between baseline hsTnI (log transformed) and 60-day clinical outcomes (death, rehospitalization, or emergency department [ED] visit). Results: Among 308 patients in the trial, 290 had baseline cTnI values available for analysis. All patients had detectable hsTnI levels at baseline, and 92% had hsTnI levels above the 99 th percentile URL. The median (IQR) hsTnI was 21.8 pg/mL (13.1, 42.9). Median hsTnI stratified by gender, left ventricular ejection fraction, HF etiology and serum creatinine (Cr) are reported in the Table. Women and those with Cr > 1.5 had higher median hsTnI values. The observed event rate was 46.2% within 60 days. We found no association between hsTnI and days free of death, rehospitalization, or ED visit after univariate analysis (P=0.11), or after adjustment for covariates (P=0.35). Conclusion: Using a high sensitivity hsTnI assay, 100% of ADHF had detectable circulating hsTnI and over 92% of patients had a hsTnI level above the 99 th percentile URL. These data suggest that such a cut point may have little relevance in the ADHF population when using high sensitivity assays. We found no association between hsTnI levels and clinical outcomes at 60 days.