Change in high-sensitivity troponin t levels and 1-year outcomes in patients with acute heart failure: China PEACE prospective heart failure study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J Li ◽  
L Zhang ◽  
C Wu
Keyword(s):  
Heart Failure ◽  
Proportional Hazards Model ◽  
Troponin T ◽  
Medical Science ◽  
Development Program ◽  
High Sensitivity ◽  
Cardiovascular Death ◽  
Cox Proportional Hazards Model ◽  
Funding Source ◽  
Ctnt Level

Abstract Background High-sensitivity cardiac troponin T (hs-cTnT) is an important prognostic marker in heart failure (HF). However, it is unclear whether the change of hs-cTnT levels can predict long-term clinical outcomes in patients with acute HF. Purpose To examine the association between change in hs-cTnT from hospital admission to 1-month after discharge and subsequent 1-year cardiovascular death or HF hospitalization in patients with acute HF. Methods We included patients hospitalized primarily for HF from 52 hospitals in China, who had central analysis of hs-cTnT at both admission and 1-month after discharge. Change in hs-cTnT was calculated as hs-cTnT level at 1-month minors that at admission. The composite outcome measure was cardiovascular death or HF hospitalization within 1 year after discharge. We tested the linearity assumption between change in hs-cTnT level and the composite events using restricted cubic splines. To further explore the quantitative association between change in hs-cTNT and the events, we also applied a Cox proportional hazards model using change in hs-cTNT as a continuous variable, adjusting for hs-cTnT level at admission (log transformed) and known prognostic variables. Results We included 2355 patients hospitalized primarily for HF. Median change in hs-cTnT from baseline was −2.7ng/L (IQR −9 to 0.7). 614 (26.1%) patients experienced the events of cardiovascular death or HF hospitalization within 1 year. Among patients with hs-cTnT <14ng/L (the upper limit of the reference value) at admission, patients had low risk of the events regardless whether hs-cTNT ≥14ng/L at 1-month or not (20.2% vs. 14.1%, p=0.11). Among patients with hs-cTnT ≥14ng/L at admission, patients with hs-cTNT ≥14ng/L at 1-month had higher risk of the events than those with hs-cTnT <14ng/L (36.4% vs. 18.6%, p<0.0001). The association between change in hs-cTnT and the events was non-linear. When change in hs-cTnT was <4ng/L and >−4ng/L, per 1 ng/L decrease was associated with a 7% reduction in risk of the events [hazard ratio (HR) 0.93, 95% CI 0.88–0.99]. When change in hs-cTnT was <−4ng/L, there was a levelling off in the reduced risk (HR: 0.99, 95% CI 0.99–1.00). While change in hs-cTnT was >4ng/L, it was not significantly associated with the events any longer (Figure 1). Conclusion Among patients hospitalized for HF, changes in hs-cTnT from admission to 1 month can predict the risk of cardiovascular death and HF hospitalization. Funding Acknowledgement Type of funding source: Other. Main funding source(s): The National Key Research and Development Program from the Ministry of Science and Technology of China; the CAMS Innovation Fund for Medical Science; the 111 Project from the Ministry of Education of China

scholarly journals Pattern and predictors of one-year mortality in heart failure: China PEACE Prospective Heart Failure Study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J Li ◽  
L Zhang ◽  
J Liu ◽  
X Bai ◽  
H Zhang ◽  
...  
Keyword(s):  
Heart Failure ◽  
Sleep Apnea Syndrome ◽  
Medical Science ◽  
Development Program ◽  
Public Health Problem ◽  
Cox Proportional Hazards Model ◽  
Funding Source ◽  
Clinical Factors ◽  
All Cause Mortality ◽  
One Year

Abstract Background Heart failure (HF) is a global public health problem, which causes high mortality. Purpose To characterize the pattern of 1-year mortality, including the rate and timing of death, and to identify clinical and non-clinical factors predicting 1-year all-cause mortality after hospitalization for HF. Methods We prospectively enrolled patients who were hospitalized primarily for HF and discharged alive from 52 hospitals across 20 provinces in China between August 2016 and May 2018, and followed them up by face-to-face interview or telephone. Patients' fatal status were ascertained according to investigators' report and national death registration. Cognitive function was measured by Mini-Cog score and health status was measured by Kansas City Cardiomyopathy Questionnaire (KCCQ). We fitted a Cox proportional hazards model accounting for hospital as random effects to identify patient characteristics associated with 1-year all-cause mortality. Results Among 4899 patients, 4882 (97.7%) completed 1-year follow-up. The median (IQR) age was 67 (57, 75) years and 37.5% were women. The main etiology of HF was ischemic heart disease (53.1%), 66.0% of patients had history of HF before the index hospitalization. Among 813 deaths within one year after discharge, 13.4% and 58.4% occurred within one months and six months, respectively. Systolic blood pressure <100mmHg at admission (hazard ratio [HR] 2.33, 95% CI 1.76–3.08), NYHA class IV (HR 1.37, 95% CI 1.1–1.7), anemia (HR 1.3, 95% CI 1.1–1.54), hs-cTNT≥18 ng/L (HR 1.84, 95% CI 1.53–2.22), hyponatremia (HR 1.66, 95% CI 1.38–1.98), LVEF<40% (HR 1.25, 95% CI 1.02–1.53), QRS interval≥120mms (HR 1.19, 95% CI 1.02–1.4), Cognitive impairment (HR 1.25, 95% CI 1.07–1.46) and low KCCQ score (HR 1.24 per 25 score decrease, 95% CI 1.11–1.39) were associated with higher risks of 1-year all-cause mortality. In contrast, female (HR 0.83, 0.7–0.99), sleep apnea syndrome (HR 0.55, 95% CI 0.35–0.88) were associated with lower risks of 1-year all-cause mortality. Conclusion In China, one in six patients hospitalized for HF die within 1-year, with the majority occurring during the first 6 months after hospital discharge. Both clinical and non-clinical factors predict 1-year mortality. Funding Acknowledgement Type of funding source: Other. Main funding source(s): The National Key Research and Development Program from the Ministry of Science and Technology of China; the CAMS Innovation Fund for Medical Science; the 111 Project from the Ministry of Education of China

scholarly journals Revisiting the obesity paradox in heart failure: Per cent body fat as predictor of biomarkers and outcome

2019 ◽  
Vol 26 (16) ◽  
pp. 1751-1759 ◽  
Author(s):  
Alberto Aimo ◽  
James L Januzzi ◽  
Giuseppe Vergaro ◽  
Aldo Clerico ◽  
Roberto Latini ◽  
...  
Keyword(s):  
Heart Failure ◽  
Body Fat ◽  
Troponin T ◽  
High Sensitivity ◽  
Obesity Paradox ◽  
Cardiovascular Death ◽  
Obese Patients ◽  
Jackson Pollock ◽  
Reduced Ejection Fraction ◽  
Patient Prognosis

Aims Obesity defined by body mass index (BMI) is characterized by better prognosis and lower plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) in heart failure. We assessed whether another anthropometric measure, per cent body fat (PBF), reveals different associations with outcome and heart failure biomarkers (NT-proBNP, high-sensitivity troponin T (hs-TnT), soluble suppression of tumorigenesis-2 (sST2)). Methods In an individual patient dataset, BMI was calculated as weight (kg)/height (m) 2 , and PBF through the Jackson–Pollock and Gallagher equations. Results Out of 6468 patients (median 68 years, 78% men, 76% ischaemic heart failure, 90% reduced ejection fraction), 24% died over 2.2 years (1.5–2.9), 17% from cardiovascular death. Median PBF was 26.9% (22.4–33.0%) with the Jackson–Pollock equation, and 28.0% (23.8–33.5%) with the Gallagher equation, with an extremely strong correlation ( r = 0.996, p < 0.001). Patients in the first PBF tertile had the worst prognosis, while patients in the second and third tertile had similar survival. The risks of all-cause and cardiovascular death decreased by up to 36% and 27%, respectively, per each doubling of PBF. Furthermore, prognosis was better in the second or third PBF tertiles than in the first tertile regardless of model variables. Both BMI and PBF were inverse predictors of NT-proBNP, but not hs-TnT. In obese patients (BMI ≥ 30 kg/m2, third PBF tertile), hs-TnT and sST2, but not NT-proBNP, independently predicted outcome. Conclusion In parallel with increasing BMI or PBF there is an improvement in patient prognosis and a decrease in NT-proBNP, but not hs-TnT or sST2. hs-TnT or sST2 are stronger predictors of outcome than NT-proBNP among obese patients.

scholarly journals 41 Circulating levels and prognostic cut-offs of sST2, high-sensitivity troponin T, and NT-proBNP in women vs. men with chronic heart failure

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Francesco Gentile ◽  
Alberto Aimo ◽  
James Lj Jannuzzi ◽  
Mark Richards ◽  
Carolyn Sp Lam ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Troponin T ◽  
High Sensitivity ◽  
Cardiovascular Death ◽  
Clinical Value ◽  
High Sensitivity Troponin ◽  
Secondary Endpoints ◽  
High Sensitivity Troponin T ◽  
Circulating Levels

Abstract Aims Limited evidence exists on sex-related differences in clinical value of biomarkers in chronic heart failure (HF). We aimed to define plasma levels, determinants, and optimal prognostic cut-offs of soluble suppression of tumourigenesis-2 (sST2), high-sensitivity troponin T (hs-TnT), and N-terminal pro-B-type natriuretic peptide (NT-proBNP) in female and male chronic HF patients. Methods and results Individual data of patients from the BIOS (Biomarkers In Heart Failure Outpatient Study) Consortium with sST2, hs-TnT, and NT-proBNP measured were analysed. The primary endpoint was a composite of 1-year cardiovascular death and HF hospitalization. The secondary endpoints were 5-year cardiovascular and all-cause death. The cohort included 4540 patients (age: 67 ± 12 years, LVEF 33 ± 13%, 1111 women, 25%). Women showed lower sST2 (24 vs. 27 ng/ml, P &lt; 0.001) and hs-TnT level (15 vs. 20 ng/l, P &lt; 0.001), and similar concentrations of NT-proBNP (1540 vs. 1505 ng/l, P = 0.408). Although the three biomarkers were confirmed as independent predictors of outcome in both sexes, the optimal prognostic cut-off was lower in women for sST2 (28 vs. 31 ng/ml) and hs-TnT (22 vs. 25 ng/l), while NT-proBNP cut-off was higher in women (2339 ng/l vs. 2145 ng/l). The use of sex-specific cut-offs improved risk prediction compared to the use of previously standardized prognostic cut-offs (Figure). Conclusions In patients with chronic HF, levels of sST2 and hs-TnT, but not of NT-proBNP are lower in women. Lower sST2 and hs-TnT and higher NT-proBNP cut-offs for risk stratification could be used in women.

P4542Revisiting the obesity paradox in heart failure: percent body fat as predictor of biomarkers and outcome

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Aimo ◽  
J Januzzi ◽  
G Vergaro ◽  
R Latini ◽  
I S Anand ◽  
...  
Keyword(s):  
Heart Failure ◽  
Body Fat ◽  
Troponin T ◽  
High Sensitivity ◽  
Obesity Paradox ◽  
Cardiovascular Death ◽  
Percent Body Fat ◽  
Obese Patients ◽  
Jackson Pollock ◽  
Patient Prognosis

Abstract Background Obesity defined by body mass index (BMI) is characterized by better prognosis and lower plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) in heart failure (HF). We assessed whether another anthropometric measure, percent body fat (PBF), reveals different associations with outcome and HF biomarkers (NT-proBNP, high-sensitivity troponin T [hs-TnT], soluble suppression of tumorigenesis-2 [sST2]). Methods In an individual patient dataset, BMI was calculated as weight (kg)/height (m)2, and PBF through the Jackson-Pollock and Gallagher equations. Results Out of 6468 patients (median 68 years, 78% men, 76% ischaemic HF, 90% reduced EF), 24% died over 2.2 years (1.5–2.9), 17% from cardiovascular death. Median PBF was 26.9% (22.4–33.0%) with the Jackson-Pollock equation, and 28.0% (23.8–33.5%) with the Gallagher equation, with an extremely strong correlation (r=0.996, p<0.001). Patients in the first PBF tertile had the worst prognosis, while patients in the second and third tertile had similar survival. The risks of all-cause and cardiovascular death decreased by up to 36% and 27%, respectively, per each doubling of PBF. Furthermore, prognosis was better in the second or third PBF tertiles than in the first tertile regardless of model variables. Both BMI and PBF were inverse predictors of NT-proBNP, but not hs-TnT. In obese patients (BMI ≥30 kg/m2, third PBF tertile), hs-TnT and sST2, but not NT-proBNP, independently predicted outcome. Conclusion Patient prognosis improves with either BMI or PBF. Obesity, assessed with BMI or PBF, is associated with lower NT-proBNP but not hs-TnT or sST2. hs-TnT or sST2 are stronger prognostic predictors than NT-proBNP among obese patients.

A single high-sensitivity cardiac troponin T compared to the HEART score for a rapid rule-out of acute myocardial infarction at a prehospital emergency clinic

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
T.R Johannessen ◽  
D Atar ◽  
O.M Vallersnes ◽  
A.C.K Larstorp ◽  
I Mdala ◽  
...  
Keyword(s):  
Primary Care ◽  
Cardiac Troponin ◽  
Troponin T ◽  
High Sensitivity ◽  
Low Risk ◽  
Symptom Duration ◽  
Funding Source ◽  
Emergency Setting ◽  
Heart Score ◽  
Rule Out

Abstract Background Patients presenting with acute chest pain outside of hospitals represent a diagnostic challenge. Purpose We aimed to validate whether a single high-sensitivity cardiac troponin T (hs-cTnT) safely can rule out acute myocardial infarction (AMI) in a primary care emergency setting. In addition, we aimed to investigate if the hs-HEART (History, Electrocardiogram (ECG), Age, Risk factors, and hs-Troponin) score would add valuable diagnostic information. Methods This is a secondary analysis from a prospective diagnostic study, including 1711 patients with acute non-specific chest pain presenting to a primary care emergency clinic from November 2016 to October 2018. The European Society of Cardiology (ESC) 0/1-hour algorithm triages patients towards direct rule-out if the 0-hour hs-cTnT is below 5 ng/L, combined with a normal ECG and a 3-hour symptom duration. The hs-HEART score (0–10 points) was calculated retrospectively, and a score ≤3 points was considered low-risk. In addition, a modified hs-HEART score, with more comparable hs-cTnT cut-off values, was applied. The primary endpoint was AMI during the index episode; the secondary the 90-day incidence of AMI (including index) and all-cause death. Results Among 1711 patients, 61 (3.6%) had an AMI, and 525 (30.7%) were assigned towards direct rule-out. With no AMIs in this group, the rule-out safety was high (negative predictive value (NPV) and sensitivity 100%). The hs-HEART score triaged more patients (n=966) as low-risk, but missed six AMIs (NPV 99.4% and sensitivity 90.2%). The modified hs-HEART score (n=707, AMI=3) increased the low-risk sensitivity to 95.1%. The 90-day incidence of AMI and all-cause death in the direct rule-out, low-risk hs-HEART, and modified hs-HEART group, were 0.0%, 0.7%, and 0.4%, respectively. Conclusions The ESC direct rule-out approach, with a single hs-cTnT below 5 ng/L, combined with a normal ECG, and a 3-hour symptom duration, is superior to the two hs-HEART scores in ruling out AMI in a primary care emergency setting. Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): The Norwegian Research Fund for General Practice

Abstract 12777: High Sensitivity Troponin T is Associated With Increased Heart Failure Risk in Metabolic Syndrome in the Atherosclerosis Risk in Communities (ARIC) Study

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Yashashwi Pokharel ◽  
Wensheng Sun ◽  
Dennis Villarael ◽  
Elizabeth Selvin ◽  
Salim Virani ◽  
...  
Keyword(s):  
Heart Failure ◽  
Metabolic Syndrome ◽  
Myocardial Injury ◽  
Troponin T ◽  
Cox Model ◽  
High Sensitivity ◽  
Cvd Risk ◽  
Chi Square ◽  
High Sensitivity Troponin ◽  
High Sensitivity Troponin T

Background: Metabolic syndrome (MS) is associated with higher CVD risk. High sensitivity troponin T (hsTnT) is a marker of myocardial injury and an emerging marker for heart failure (HF) risk prediction. We examined whether hsTnT is associated with increased HF risk in people with similar number of MS components present at baseline in 10316 ARIC participants without prevalent HF. Methods: We used Wald Chi-square test to assess the interaction between MS and hsTnT and Cox model for the association of incident HF hospitalization by hsTnT categories across groups created by the number of MS components after adjusting for risk factors and NT-proBNP (Table). Results: The mean age of the study population was 63 (SD, 6) years (56% women). Mean hsTnT levels were higher with increasing MS components (Table). There were 1353 HF hospitalizations over a median of 14 years. The interaction of MS with hsTnT for HF was borderline significant (p-interaction 0.059). Compared to individuals without MS and hsTnT<5 ng/L the HRs (95%CIs) were 1.7 (1.4-2.1) in those without MS and hsTnT≥5 ng/L; 1.7 (1.3-2.1) in MS and hsTnT<5 ng/L; and 3.6 (3.0-4.4) in MS and hsTnT≥5 ng/L. In groups with 1-5 MS components present, increasing hsTnT was significantly associated with higher hazards for HF in each group with the highest HR in those with all 5 MS components (Table). Conclusion: Presence of higher MS risk components was associated with increasing subclinical myocardial injury as assessed by higher hsTnT. The hazards for HF were numerically similar in individuals without MS but detectable hsTnT (>5 ng/L) as to those with MS but undetectable hsTnT. In people with similar number of MS components higher hsTnT levels were associated with increased HF hazards suggesting that in MS hsTnT could be a useful marker for identifying those at higher risk for incident HF.

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