Prognostic Value Of Cardiac Troponin Research Articles

Prognostic Value of Cardiac Troponin I and L-Lactate in Blood of Dairy Cows Affected by Downer Cow Syndrome.

BackgroundThe downer cow syndrome (DCS) is a challenging health issue in the dairy industry. No cow‐side test is available to provide an accurate prognosis for DCS cases in farm settings.Hypothesis/ObjectivesLocal or systemic hypoperfusion and myocardial lesions lead to an increase in blood concentration of biomarkers cardiac troponin I (cTnI) and L‐lactate. The objective was to determine the prognostic values of these biomarkers assessed cow‐sides in addition to clinical examinations in prognostication of a negative outcome (NO: death or euthanasia within 7 days).Animals218 client‐owned dairy cows affected by DCS.MethodsIn a prospective study, animals were monitored for 60 days after inclusion of each cow. Blood cTnI and L‐lactate concentrations were measured on the day of inclusion. The prognostic accuracy of both biomarkers and physical examination variables was estimated to predict NO. A mixed multivariable logistic regression model was used for data analysis.ResultsPrevalence of NO in this study was 63% on day 7. Troponin concentrations greater than 0.7 ng/mL had sensitivity and specificity of 54.1% (95% CI: 45.3–62.7%) and 78.4% (95% CI: 67.3–87.1%), respectively, for predicting NO. Blood L‐lactate was not associated with the outcome. The multivariable model revealed that heart rate >100 bpm (OR; 95% CI: 3.7; 1.3–10.2) and cTnI > 0.7 ng/mL (OR; 95% CI: 5.5; 2.1–14.6) were associated with the risk of NO.Conclusions and Clinical ImportanceHypertroponinemia and tachycardia were associated with reduced survival in DCS cases. The use of cow‐side blood cTnI concentrations and heart rate could help to rapidly identify cows in farm setting that have poor chances of recovery and would benefit from a more aggressive treatment or euthanasia.

Association of high-sensitivity cardiac troponin T with mortality and cardiovascular events in a community-based prospective study in Beijing

ObjectiveThe prognostic value of cardiac troponins in apparently healthy populations is not well established. The aim of this study was to investigate the prognostic properties of high-sensitivity cardiac troponin T...

Prognostic Value of Cardiac Troponin T and Sex in Patients Undergoing Elective Percutaneous Coronary Intervention.

BackgroundIn patients with stable coronary artery disease undergoing elective percutaneous coronary intervention, the prognostic value of high‐sensitivity cardiac troponin T (hs‐cTnT) and the influence of sex remain poorly defined.Methods and ResultsConsecutive patients with stable coronary artery disease who underwent elective percutaneous coronary intervention were included. Primary endpoint was all‐cause mortality. Unadjusted hazard ratio (HR) in overall and sex‐specific population and multivariable adjusted HR were calculated by using Cox proportional hazard models. In a total of 5626 patients, elevated hs‐cTnT levels, more than the sex‐specific 99th percentile upper reference limit of normal (URL), were observed in 2221 patients (39%) at baseline. During follow‐up (median, 14.5 months; 25th–75th percentiles, 6.4–27.2 months), 265 patients died. Mortality was higher in patients with the sex‐specific 99th percentile URL compared to those with normal hs‐cTnT (17.3% vs 3.4%; HR=6.10; 95% CI, 4.58–8.14; P<0.001). hs‐cTnT was an independent predictor of mortality in multivariable adjusted models. The C‐statistic was significantly increased by adding hs‐cTnT to the basic prediction model for mortality (0.793–0.815; P<0.001). There was a significant interaction between hs‐cTnT and sex on mortality. Differences in all‐cause mortality between patients with more than the sex‐specific 99th percentile URL and those with normal hs‐cTnT were numerically larger in male than female patients (male, HR=6.45; 95% CI, 4.68–8.87, P<0.001; female, HR=4.29, 95% CI, 2.36–9.03; P<0.001).ConclusionsIn patients with stable coronary artery disease undergoing elective percutaneous coronary intervention, preprocedural hs‐cTnT was a strong predictor of mortality in both men and women.

Prognostic value of cardiac troponin I during acute exacerbation of chronic obstructive pulmonary disease: A prospective study.

Background:Chronic obstructive pulmonary disease (COPD) is a major cause of mortality and morbidity. It is the fourth leading cause of death worldwide. Acute exacerbations of COPD are common and are associated with worsening lung function and mortality.Objectives:To evaluate the prevalence of elevation of cTnI in patients admitted with acute exacerbation of COPD and to study its association with the need for ventilator support, duration of hospital stay, and in-hospital mortality.Methods:In a prospective design, 50 patients admitted to our hospital with acute exacerbation of COPD were included. cTnI was assayed in a blood sample obtained at admission and 24 h later. Levels above 0.017 µg/L were taken as positive. The following data were also recorded–demographic data, pattern of tobacco use, clinical symptoms and signs, comorbidities, Glasgow Coma Scale, arterial blood gas, electrocardiogram/two-dimensional echocardiography, chest X-ray, and peak expiratory flow rate.Results:Among the 50 patients, 4 were females, and 46 were males. cTnI was positive in 32% of patients with a mean value of 0.272. Patients with cTnI positive were taken as Group I and those with negative were included in Group II. Prevalence of comorbidities was higher in cTnI positive group, so was the duration of COPD. cTnI elevation correlated significantly with the need for ICU admission and ventilator support. No significant difference was found in the duration of ventilator support, hospital stay, and in-hospital mortality.Conclusion:cTnI is elevated in a significant subset of patients with acute exacerbation of COPD. Duration of their illness was longer, higher incidence of ischemic heart disease was also found in these patients. Patients with cTnI elevation are more likely to require ICU care and ventilator support. However, it did not predict in-hospital mortality. Thus, it can be used as a marker to identify high-risk patients during acute exacerbation of COPD.

GW26-e4462 Prognostic value of cardiac troponin T and plasma lactate levels among patients with acute pulmonary embolism

GW26-e4462 Prognostic value of cardiac troponin T and plasma lactate levels among patients with acute pulmonary embolism

The assessment of risk stratification and prognostic value of cardiac troponin I in patients with acute pulmonary embolism

Objective To investigate the assessment of risk stratification and prognostic value of cardiac troponin I (cTn I) in patients with acute pulmonary embolism (APE). Methods A total of 178 patients with APE in our hospital from January 2007 to December 2007 were collected and divided into cTn I + group (0.012 ng/ml) or higher and cTn I-group (<0.012 ng/ml) according to the initial inspection cTn I level. The pulmonary embolism severity index (PESI) was used for clinical risk determination and electrocardiography (ECG), echocardiography, imaging results, and positive and adverse were recorded. Results Among 178 consecutive patients with confirmed acute PE; 96 (53.9%) were cTnI+ and 82 (46.1%) were cTnI-. hard events cTn I+ and cTn I-71 cases (74.0%) and 0, respectively (P=0.000). soft events cTn I+ and cTn I-were 80 cases (83.3%) and 18 cases (22.0%), respectively (P=0.000). Kaplan Meier curve showed that patients in cTn I-groups had higher survival free of hard (P=0.000) or soft (P= 0.000) events, irrespective of clinical risk. Conclusions Highly sensitive cTn I assay provides an excellent prognostic negative predictive value, thus it has a role in identification of candidates for out-of-hospital treatment of acute PE. Key words: Troponin I/ME; Pulmonary embolism/ME; Risk; Prognosis

Impact of sex on the prognostic value of high-sensitivity cardiac troponin I in the general population: the HUNT study.

A new, high-sensitivity assay for cardiac troponin I (hs-cTnI) permits evaluation of the prognostic value of cardiac troponins within the reference interval. Men have higher hs-cTnI concentrations than women, but the underlying pathophysiological mechanisms and prognostic implications are unclear. The aim of this study was to assess the potential impact of sex on the association between hs-cTnI and cardiovascular death. By use of the Architect STAT High-Sensitive Troponin assay, we measured hs-cTnI in 4431 men and 5281 women aged ≥20 years participating in the prospective observational Nord-Trøndelag Health Study (HUNT). hs-cTnI was detectable in 98.5% of men and 94.7% of women. During a mean follow-up period of 13.9 years, 708 cardiovascular deaths were registered. hs-cTnI was associated with the incidence of cardiovascular death [adjusted hazard ratio (HR) per 1 SD in log hs-cTnI 1.23 (95% CI 1.15-1.31)], with higher relative risk in women than men [HR 1.44 (1.31-1.58) vs 1.10 (1.00-1.20); Pinteraction < 0.001]. This finding was mediated by both lower risk associated with low hs-cTnI concentrations in women than in men and higher risk associated with high concentrations of hs-cTnI in women than in men. Male sex was associated with a higher risk of cardiovascular death [HR 1.28 (1.11-1.49)], but after adjustment for hs-cTnI, this association disappeared [HR 0.87 (0.75-1.02)]. The prognostic value of hs-cTnI concentrations in the general population is stronger in women than in men. Subtle impairment of cardiovascular status may contribute to higher hs-cTnI concentrations in men, reflecting sex-dependent differences in cardiovascular risk.

Cardiac and oxidative stress biomarkers in Trypanosoma evansi infected camels: diagnostic and prognostic prominence.

This study was conducted to investigate the level of cardiac and oxidative stress markers in camels infected with Trypanosoma evansi and to explore the diagnostic and prognostic value of cardiac troponin I (cTnI) and creatine kinase-myocardial band (CK-MB) in response to infection. Seventy four dromedary camels with clinical and laboratory evidence of trypanosomosis and 20 healthy controls were included in this study. Serum cTnI, CK-MB, CK, malondialdehyde (MDA) and super oxide dismutase (SOD) were measured. The values of cTnI, CK-MB, CK and MDA were significantly higher, whereas SOD level was lower in T. evansi infected camel. Successfully treated camels (n = 43) had lower levels of cTnI, CK-MB, CK and MDA, but higher level of SOD compared to camels with treatment failure. Both cTnI and CK-MB showed high degree of accuracy in predicting treatment outcome (success vs failure). The area under the curve for cTnI and CK-MB was 0.98 and 0.93, respectively. However, cTnI showed better sensitivity and specificity than CK-MB (Se = 96.8% vs 83.9% and Sp = 100% vs 88.5%, respectively). These results suggest that cTnI and CK-MB could be used as diagnostic and prognostic biomarkers in camels infected with T. evansi.

Prognostic value of cardiac troponin in patients with chronic kidney disease without suspected acute coronary syndrome: a systematic review and meta-analysis.

Clinicians face uncertainty about the prognostic value of troponin testing in patients with chronic kidney disease (CKD) without suspected acute coronary syndrome (ACS). To systematically review the literature on troponin testing in patients with CKD without ACS. MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials through May 2014. Studies examining elevated versus normal troponin levels in patients with CKD without ACS. Paired reviewers selected articles for inclusion, extracted data, and graded strength of evidence (SOE). Meta-analyses were conducted when studies had sufficient homogeneity of key variables. Ninety-eight studies met inclusion criteria. Elevated troponin levels were associated with all-cause and cardiovascular mortality among patients receiving dialysis (moderate SOE). Pooled hazard ratios (HRs) for all-cause mortality from studies that adjusted for age and coronary artery disease or a risk equivalent were 3.0 (95% CI, 2.4 to 4.3) for troponin T and 2.7 (CI, 1.9 to 4.6) for troponin I. The pooled adjusted HRs for cardiovascular mortality were 3.3 (CI, 1.8 to 5.4) for troponin T and 4.2 (CI, 2.0 to 9.2) for troponin I. Findings were similar for patients with CKD who were not receiving dialysis, but there were fewer studies. No study tested treatment strategies by troponin cut points. Studies were heterogeneous regarding assays, troponin cut points, covariate adjustment, and follow-up. In patients with CKD without suspected ACS, elevated troponin levels were associated with worse prognosis. Future studies should focus on whether this biomarker is more appropriate than clinical models for reclassifying risk of patients with CKD and whether such classification can help guide treatment in those at highest risk for death. Agency for Healthcare Research and Quality.

Serum Troponin-I as a prognostic marker in acute exacerbated chronic obstructive pulmonary disease patients

BackgroundChronic Obstructive Pulmonary Disease (COPD) is a major cause of chronic morbidity and mortality worldwide. It is the fifth leading cause of death worldwide. The spectrum of cardiovascular complications associated with COPD is clearly broad, right ventricular (RV) dysfunction and pulmonary vascular disease are common in COPD and progress with time. In RV failure, cardiac Troponins (cTn) are suspected to be elevated secondary to RV ischemia or micro infarction. ObjectiveTo evaluate the prognostic value of cardiac Troponin I level in acute exacerbated chronic obstructive pulmonary diseases (AECOPD) and its impact on the hospital outcome in those patients. Patients and methodsThis study was performed on 60 patients with AECOPD, admitted at Chest Department and respiratory ICU; Zagazig University hospital. All patients were subjected to: thorough history taking, clinical examination, electrocardiography and echocardiography, arterial blood gas (ABG) analysis, measure forced vital capacity (FVC) and forced expiratory volume in first second (FEV1), serum assay of cTnI level which is considered −ve if <0.01ng/ml and +ve if ⩾0.01ng/ml. ResultscTnI was positive in 42 AECOPD patients. cTnI positivity was more prominent among patients with very severe exacerbation of COPD and in those with past history of LTOT, MV, ICU admission. Also, cTnI positivity was more in patients admitted to ICU rather than those managed in the ward and among patients who needed MV rather than who did not need it and in patients who failed weaned rather that who succeeded weaned. P-pulmonate, Rt. ventricular strain, high pulmonary artery pressure, hypoxemia and hypercapnia showed a great effect upon cTnI positivity. The duration of hospitalization was longer among cTnI +ve patients than cTnI −ve ones, Tropinin cutoff value for the prediction of death was >0.055ng/ml with Sensitivity=75%, Specificity=68%. ConclusionPositive cTnI in AECOPD patients may suggest exacerbation severity and the occurrence of pulmonary hypertension and right ventricular dysfunction. Positive cTnI is considered as good prognostic marker for the possibility of a need for MV and a longer duration of hospitalization. MV may further elevate cTnI in AECOPD patients and with possible weaning failure. Negative cTnI and cTnI⩽0.055μg/L can be considered predictors of survival in AECOPD patients.

Prognostic Value of Cardiac Troponin I Measured With a Highly Sensitive Assay in Patients With Stable Coronary Artery Disease

The aims of this study were to assess the prognostic value of cardiac troponin I levels, measured with a new high-sensitivity assay, in low-risk patients with stable coronary artery disease (CAD) and to contrast its determinants and prognostic merit with that of high-sensitivity cardiac troponin T (hs-TnT). New, highly sensitive cardiac troponin assays permit evaluation of the association between troponin levels and outcomes in patients with stable CAD. High-sensitivity cardiac troponin I (hs-TnI) levels at baseline were assessed in 3,623 patients with stable CAD and preserved systolic function enrolled in the PEACE (Prevention of Events With Angiotensin-Converting Enzyme Inhibitor Therapy) trial. In total, 98.5% of patients had hs-TnI concentrations higher than the detection level (1.2 pg/ml). hs-TnI correlated moderately with hs-TnT (r = 0.44) and N-terminal pro-B-type natriuretic peptide (r = 0.39) but only weakly with age (r = 0.17) and estimated glomerular filtration rate (r = -0.11). During a median follow-up period of 5.2 years, 203 patients died of cardiovascular causes or were hospitalized for heart failure, and 209 patients had nonfatal myocardial infarctions. In analyses adjusting for conventional risk markers, N-terminal pro-B-type natriuretic peptide, and hs-TnT, hs-TnI levels in the fourth compared with the 3 lower quartiles were associated with the incidence of cardiovascular death or heart failure (hazard ratio: 1.84; 95% confidence interval: 1.30 to 2.61; p < 0.001). [corrected]. There was a [corrected] weaker association with nonfatal myocardial infarction (hazard ratio: 1.37; 95% confidence interval: 0.98 to 1.92; p = 0.066). [corrected]. In the same models, hs-TnT concentrations were associated with the incidence of cardiovascular death or heart failure but not of myocardial infarction. In patients with stable CAD, hs-TnI concentrations are associated with cardiovascular risk independently of conventional risk markers and hs-TnT. (Prevention of Events With Angiotensin-Converting Enzyme Inhibitor Therapy [PEACE]; NCT00000558).

Prognostic value of cardiac troponins in elderly patients with hip fracture—a systematic review

Cardiac troponins can be elevated in cardiac ischemic conditions or other diseases such as pulmonary embolism or renal failure, where they may predict outcome. We hypothesized that cardiac troponins offer useful prognostic information regarding morbidity and mortality in elderly hip fracture patients undergoing surgical therapy. A literature review was conducted using PubMed and CINAHL plus with full text (EBSCOhost). Articles with original data relating troponins to prognosis in elderly hip fracture patients were reviewed. Studies with patients not undergoing surgery or undergoing elective or nonhip fracture surgery were excluded. Six papers met inclusion criteria. Troponin elevation was seen in 26.7-39% of patients, while myocardial infarction, cardiac complications, and cardiac death occurred in ≤35% troponin-positive patients in four of six studies. Several noncardiac factors were associated with elevated troponin including higher American Society of Anaesthesiologists score, current smoking, reduced mobility/activity level, lower hemoglobin, and living in residential care. Patients with elevated troponin had longer lengths of stay, increased risk for discharge to long-term care facilities, and higher mortality. Increased age, male sex, and higher American Society of Anaesthesiologists score were also associated with mortality. Elevated troponin can be used as a marker of increased morbidity/mortality in elderly hip fracture patients undergoing surgery, as hypothesized, even in the absence of cardiac complications. Perioperative troponin evaluation may be useful for risk stratification, but further studies are needed to clarify risks and benefits of such testing.

Cardiac troponin I does not independently predict mortality in critically ill patients with severe sepsis

Patients with sepsis often have elevated cardiac troponin I even in the absence of coronary artery disease. The prognostic value of cardiac troponins in critically ill patients with sepsis remains debatable. Our objective was to evaluate the prognostic value of cardiac troponin I in critically ill patients with severe sepsis. In this retrospective study, we included patients with severe sepsis who had troponin assayed within 12 h of admission to intensive care over a 6 year period. Patients who had myocardial infarction at intensive care admission in the setting of sepsis were excluded. Included patients were classified into two groups based on their serum troponin I levels: low troponin group (troponin ≤ 0.1 µg/L) and elevated troponin group (troponin > 0.1 µg/L). The primary outcome of interest was hospital mortality. The secondary outcome measures included intensive care mortality, intensive care and hospital length of stay. A total of 382 patients were admitted to intensive care with sepsis. Of these, 293 patients were included in analyses. There was a statistically significant difference in hospital (15% vs 36.1%; P < 0.01) and intensive care (11% vs 25%; P < 0.01) mortality, but not in intensive care and hospital duration of stay. Logistic regression analysis revealed temperature, simplified acute physiology score II and serum lactate to be independent predictors of hospital mortality. Cardiac troponin I was not an independent predictor of hospital mortality. Critically ill patients with severe sepsis who had elevated troponin had increased hospital and intensive care mortality. However, cardiac troponin I did not independently predict hospital mortality.

Prognostic value of cardiac troponin T in patients with moderate to severe heart failure scheduled for cardiac resynchronization therapy

Prognostic value of cardiac troponin T in patients with moderate to severe heart failure scheduled for cardiac resynchronization therapy

Abstract 9150: Re-Elevation of Troponin Following Percutaneous Coronary Intervention Significantly Predicts 1-Year Mortality in Patients with High-risk Non-ST-Segment Elevation Acute Coronary Syndromes

Background: The prognostic value of cardiac troponin (cTn) elevation post PCI is controversial. Moreover, in high-risk NSTE ACS patients presenting with elevated necrosis markers, the ability to use cTn to detect post-PCI MI is especially challenging: primarily this relates to discriminating PCI-related elevation from natural evolution of presenting MI. We addressed this issue by reviewing each cTn trend during the index ACS admission in all patients undergoing PCI randomized in the EARLY ACS (n=5552) and SYNERGY (n=4647) trials. Methods: Time and cTn value (indexed by ULN) data pairs were plotted into graphics for each of 10,199 pts and independently reviewed by 2 physicians to detect post-PCI cTn (re)elevation (example in figure). Post-PCI cTn peak was identified for each plot, and the relationship between peak cTn post PCI and 1-year mortality was evaluated using Cox proportional hazard modeling, correcting for the 15 clinical variables of the EARLY ACS 1-year mortality model (including baseline cTn). Results: Patients were classified into 3 groups: (i) (re)elevation post PCI not evaluable because cTn values rising through the time of PCI (group 1; N=4427 [43%]; excluded from further analyses); (ii) cTn values stable/falling with post-PCI (re)elevation detected (group 2; N=4276 [42%]); (iii) cTn values stable/falling but without post-PCI (re)elevation (group 3; n=1496 [15%]). In the multivariable model including patients in groups 2 and 3, peak cTn post PCI was significantly associated with a 7% increase in hazard of death per each 10xULN increase (adj. HR 1.07; 95% CI 1.03-1.11; p=0.0008). Conclusion: We describe a methodology that allows clear differentiation of post-PCI cTn (re)elevation from presenting MI in over half of high-risk NSTE ACS patients undergoing PCI. This approach identified a highly significant relationship between post-PCI cTn and 1-year mortality and has relevance for the incorporation of cTn for definition of post-PCI MI.

An Assessment of the Concentration-Related Prognostic Value of Cardiac Troponin I Following Acute Coronary Syndrome

In 2004 the British Cardiac Society redefined myocardial infarction by cardiac troponin I (cTnI) concentration: ≤ 0.06 μg/L (unstable angina), >0.06 to < 0.5 μg/L (myocardial necrosis), and ≥ 0.5 μg/L (myocardial infarction). We investigated the effects of this classification on all-cause mortality in 1,285 patients from the Evaluation of the Methods and Management of Acute Coronary Events (EMMACE)-2 registry. There were 528 deaths (6.6-year all-cause mortality 41.1%). Survival was greatest in the cTnI ≤ 0.06-μg/L subgroup at 30 days (p = 0.005), 6 months (p = 0.015), 1 year (p = 0.002), and 6.6 years (p = 0.045). After adjustment there was no significant difference in survival between the cTnI >0.06- to < 0.5-μg/L and ≥ 0.5-μg/L subgroups. Increased mortality (hazard ratio, 95% confidence interval) was associated with ages 70 to 80 years (2.58, 1.17 to 3.91) and >80 years (3.30, 3.50 to 5.06), peripheral vascular disease (1.50, 1.16 to 1.94), heart failure (1.36, 1.05 to 1.83), diabetes mellitus (1.68, 1.36 to 2.07), severe left ventricular systolic dysfunction (1.50, 1.00 to 2.21), and creatinine per 10 μmol/L (1.65, 1.02 to 1.08), whereas ages 50 to 60 years (0.55, 0.32 to 0.96), β blockers (0.53, 0.44 to 0.64), aspirin (0.80 0.65 to 0.99), angiotensin-converting enzyme inhibitors (0.67, 0.56 to 0.80), statins (0.73, 0.59 to 0.90), and revascularization (0.33, 0.12 to 0.92) were associated with a lower risk of death. In conclusion, although quantitative evaluation of cTnI concentration in patients with acute coronary syndrome with cTnI > 0.06 μg/L was associated with no added prognostic information, the dichotomization of patients by cTnI status ("positive" and "negative") facilitates acute coronary syndrome risk stratification.

P1-476 An assessment of the concentration-related prognostic value of cardiac troponin I in 1285 patients following acute coronary syndrome

IntroductionThe British Cardiac Society, in 2004, redefined myocardial infarction by troponin concentration: cTnI ≤0.06 μg/l (unstable angina), cTnI >0.06 μg/l to <0.5 μg/l (myocardial necrosis), and cTnI≥0.5 μg/l (myocardial infarction)....

Prognostic value of cardiac troponin T in patients with moderate to severe heart failure scheduled for cardiac resynchronization therapy

Predicting response to cardiac resynchronization therapy (CRT) is challenging. Highly sensitive cardiac troponin T (hsTnT) might predict response to CRT and identify patients at a high risk of experiencing severe cardiovascular events. We investigated whether baseline levels of hsTnT were associated with response to CRT and with severe cardiovascular events after long-term follow-up. Eighty-one consecutive patients were included according to the current guidelines for CRT. Biochemical, functional, and clinical parameters were assessed at baseline and at 3, 6, and 12 months of follow-up; and mortality/cardiac transplantation after 46 ± 6 months of follow-up was investigated. Cardiac magnetic resonance imaging and echocardiography were used to assess left ventricular function including viability and remodeling. Seventy-five patients completed 12 months of follow-up; and after a follow-up of 46 ± 6 months, a total of 15 patients died, 13 of these from cardiovascular causes, and 7 underwent heart transplantation. Baseline hsTnT <15 ng/L predicted response to CRT and was associated with a more favorable outcome with regard to severe cardiovascular events. Multivariate analysis found that presence of transmural scar tissue/fibrosis on magnetic resonance imaging and use of statins were independently associated with higher concentrations of hsTnT at baseline. There was a strong correlation between hsTnT and N-terminal pro-B-type natriuretic peptide levels. Highly sensitive TnT levels were elevated in the majority of heart failure patients who were scheduled for CRT. The HsTnT levels predicted response to CRT as well as long-time survival.

Long-Term Prognostic Value of Cardiac Troponin I and T Versus Creatine Kinase-MB Mass After Cardiac Surgery in Low-Risk Patients with Stable Symptoms

The long-term prognostic value of elevated cardiac biomarkers after elective cardiac surgery is not clear. The recent guidelines for diagnosing perioperative infarcts have advocated the use of similar thresholds for creatine kinase-MB (CK-MB) mass and the cardiac troponins. However, few previous data are available comparing these biomarkers after cardiac surgery, and it is not clear whether postoperative elevations of the troponins can be treated the same as elevations of CK-MB. We sought to compare the prognostic value of the cardiac troponins versus the CK-MB mass after elective cardiac surgery in low-risk patients with stable symptoms. A total of 204 consecutive patients undergoing cardiac surgery were included in the final analysis. Blood samples were drawn just before and 1 to 3 and 4 to 8 hours after the procedure, and every morning for 3 days thereafter. Patients with elevated baseline values were excluded. Using a cutoff value of 5 times the reference, patients with high and low values (controls) of CK-MB mass, cardiac troponin T (cTnT) and cardiac troponin I (cTnI) were compared. The median follow-up time was 92 months. None developed new Q-waves on the electrocardiogram. The incidence of the composite end point of all-cause mortality, readmission for acute coronary syndrome, and target vessel revascularization in the high CK-MB group was 41.2% compared to 21.8% in the controls (p = 0.004). The corresponding values for cTnT were 33.3% and 20.4% (p = 0.075) and for cTnI were 27.0% and 34.6% (p = 0.237). The p value in the isolated coronary artery bypass grafting subgroup (n = 156) was p = 0.043 for CK-MB, p = 0.137 for cTnT, and p = 0.795 for cTnI. High CK-MB (p = 0.001), ejection fraction (p = 0.002), and body mass index (p = 0.010) were the only variables independently related to reduced event-free survival. No such relation was found for high cTnT and cTnI. In conclusion, CK-MB was superior to the cardiac troponins (values > or =5 times the reference) in predicting long-term event-free survival after elective cardiac surgery in low-risk patients with stable symptoms undergoing coronary artery bypass grafting and/or valve surgery.

Elevation of cardiac troponin I during non-exertional heat-related illnesses in the context of a heatwave

IntroductionThe prognostic value of cardiac troponin I (cTnI) in patients having a heat-related illness during a heat wave has been poorly documented.MethodsIn a post hoc analysis, we evaluated 514 patients admitted to emergency departments during the August 2003 heat wave in Paris, having a core temperature >38.5°C and who had analysis of cTnI levels. cTnI was considered as normal, moderately elevated (abnormality threshold to 1.5 ng.mL-1), or severely elevated (>1.5 ng.mL-1). Patients were classified according to our previously described risk score (high, intermediate, and low-risk of death).ResultsMean age was 84 ± 12 years, mean body temperature 40.3 ± 1.2°C. cTnI was moderately elevated in 165 (32%) and severely elevated in 97 (19%) patients. One-year survival was significantly decreased in patients with moderate or severe increase in cTnI (24 and 46% vs 58%, all P < 0.05). Using logistic regression, four independent variables were associated with an elevated cTnI: previous coronary artery disease, Glasgow coma scale <12, serum creatinine >120 μmol.L-1, and heart rate >110 bpm. Using Cox regression, only severely elevated cTnI was an independent prognostic factor (hazard ratio 1.93, 95% confidence interval 1.35 to 2.77) when risk score was taken into account. One-year survival was decreased in patients with elevated cTnI only in high risk patients (17 vs 31%, P = 0.04).ConclusionscTnI is frequently elevated in patients with non-exertional heat-related illnesses during a heat wave and is an independent risk factor only in high risk patients where severe increase (>1.5 ng.mL-1) indicates severe myocardial damage.