Abstract
In patients presented to emergency rooms, Pro hormone of Natriuretic Peptide (Pro BNP) essay is overly sensitive test to rule out heart failure but less specific in predicting outcomes in follow-ups, in this study we ought to find the added value of High Sensitivity cardiac Troponin I (Hs-cTn I), in patients presented acutely with heart failure and its impact on mortality when Pro BNP is highly elevated. Prospective cohort study, inclusion criteria were age above 18 and clearly positive NT Pro BNP > 1000 pg/ml, with 12 months follow up period, primary end point was mortality from heart failure, secondary endpoint was need for rehospitalization. 95 patients were enrolled, divided into overt and non-overt pulmonary edema groups. Mean (Pro BNP) was 6184 and 5927 pg/ml and mean (Hs-cTn I) were 19.27 and 0.17 ng/ml respectively, Mean Ejection fraction was 48 ± 7 and 47 ± 7 for each group sequentially. Mortality rate was 4 (13%) in the higher Hs-c Tn I group, and 1 (1.6%) in the low troponin level group p = .03, odd ratio was 8.5, 95% CI (0.9–80). Need for re-hospitalization was present in 12 (38%) Vs 7 (8%) patients, p = .0081, odd ratio 4.8, 95% CI (1.7–14.2). In COX proportional hazard analysis, only Hs-cTn I was a significant predictor of poor outcome in this high-risk cohort with p = 0.0001. Adding (Hs-cTrop I) assay to the panel of laboratory testing, in patients presented to ER with acute heart failure and with high Pro-BNP > 1000, may further predicts mortality and rehospitalization rate.
Highlights
Acute cardiac pulmonary edema secondary to heart failure carries a bad prognosis
Mean Pro Beta natriuretic peptide (BNP) levels were 6148, 5927 pg/ml while Highly sensitive cardiac Troponins (Hs-cTn) were 19.27 and 0.17 ng/ ml respectively, mean Body mass index (BMI) of 35 and 29.8, for each group
Other risk factors and clinical findings are depicted on (Table 1), of note there were more cases of atrial fibrillation in the non-overt pulmonary edema group compared to the overt pulmonary edema 41vs 19%
Summary
Acute cardiac pulmonary edema secondary to heart failure carries a bad prognosis. Beta natriuretic peptide (BNP) and N-terminal Pro BNP are the gold standard biomarkers used for diagnosis and prognosis, more novel biomarkers like Mid-Regional pro ADrenoMedullin (MR-proADM) Mid-Regional pro Atrial Natriuretic Peptide (MR-proANP), Highly sensitive cardiac Troponins (Hs-cTn), soluble Suppression of Tumorigenicity 2 (sST2), Growth Differentiation Factor (GDF)-15 and Galectin-3, may have a role to play in determining prognosis far and beyond the one established by natriuretic peptides, but their potential role in clinical care of patients with heart failure is yet to be fully determined[1]. There are many studies that looked at the utility of using pro-BNP, the natural peptides produced by atria, due to stretching effect of elevated cavitary pressure, and its value in diagnosing pulmonary edema. It can discriminate cardiac from other causes of lung infiltrates like acute respiratory syndrome and pneumonia. In this study we ought to find the added value of Hs-cTn in patients presented acutely to the emergency room with dyspnea and highly elevated Pro BNP and its impact on predicting death and re-hospitalization over 12-month time
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