scholarly journals “HIGH sensitivity Troponins In Patients With Elevated Pro BNP and Acute Heart Failure”. (HIGH-TRIP Trial)

2021 ◽  
Author(s):  
Wesam A AlHejily
Keyword(s):  
Heart Failure ◽  
Acute Heart Failure ◽  
Troponin I ◽  
Hazard Analysis ◽  
High Sensitivity ◽  
Added Value ◽  
Emergency Rooms ◽  
Rehospitalization Rate ◽  
Cox Proportional Hazard

Abstract Background:In patients presented to emergency rooms NT-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 HS-Troponin I, in patients presented acutely with heart failure and its impact on mortality when Pro BNP is highly elevated.Methods: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.Results:95 patients were enrolled, divided into overt and non-overt pulmonary edema groups. Mean (NT-Pro BNP) was 6184 and 5927 pg/ml and mean (Hs-c Trop I) were 19.27 and 0.17ng/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 Troponin 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 was a significant predictor of poor outcome in this high-risk cohort with p=0.0001.Conclusion: Adding (Hs-cTroponin 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.

scholarly journals Prognostic value of biomarkers and co-morbidities in patients with acute heart failure: One-year follow-up study

2017 ◽  
Vol 145 (3-4) ◽  
pp. 118-123
Author(s):  
Dejan Petrovic ◽  
Marina Deljanin-Ilic ◽  
Sanja Stojanovic
Keyword(s):  
Heart Failure ◽  
Renal Failure ◽  
Chronic Renal Failure ◽  
Acute Heart Failure ◽  
Troponin I ◽  
Prognostic Significance ◽  
Systolic Pressure ◽  
High Sensitivity ◽  
Clinical Group ◽  
One Year

Introduction/Objective. Clinical risk stratification of patients hospitalized due to acute heart failure (AHF) applying B-type natriuretic peptide (BNP), troponin I (TnI), and high-sensitivity C-reactive protein (hsCRP) biochemical markers can contribute to early diagnosis of AHF and lower mortality rates. The aim of this study was to investigate the prognostic significance of biomarkers (BNP, TnI, and hsCRP) and co-morbidities concerning one-year mortality in patients with AHF. Methods. Clinical group comprised 124 consecutive unselected patients, age 60?80 years, treated at the Coronary Care Unit of the Niska Banja Institute, Nis. The patients were monitored for one year after the discharge. During the first 24 hours after admission, BNP, TnI, and hsCRP were measured in fasting serum. Results. Total one-year mortality was 29.8%. The levels of serum BNP were significantly higher in the group of non-survivors compared to the group of survivors (1353.8 ?} 507.8 vs. 718.4 ?} 387.6 pg/mL, p < 0.001). We identified several clinical and biochemical prognostic risk factors by univariate and multivariate analysis. Independent predictors of one-year mortality were the following: BNP, TnI, depression, hypotension, chronic renal failure, ejection fraction, and right-ventricle systolic pressure. Conclusion. The presence of BNP and TnI biomarkers and several co-morbidities such as depression or chronic renal failure have significant influence on one-year mortality in patients with AHF.

scholarly journals Use of Myeloperoxidase for Risk Stratification in Acute Heart Failure

2010 ◽  
Vol 56 (6) ◽  
pp. 944-951 ◽  
Author(s):  
Tobias Reichlin ◽  
Thenral Socrates ◽  
Patrick Egli ◽  
Mihael Potocki ◽  
Tobias Breidthardt ◽  
...  
Keyword(s):  
Heart Failure ◽  
Diagnostic Accuracy ◽  
Acute Heart Failure ◽  
Hazard Analysis ◽  
Hazard Ratio ◽  
Limited Area ◽  
Proportional Hazard ◽  
Cox Proportional Hazard ◽  
Mortality Hazard ◽  
Mortality Hazard Ratio

Abstract Background: Myeloperoxidase (MPO) is a biomarker of inflammation and oxidative stress produced by neutrophils, monocytes, and endothelial cells. Concentrations of MPO predict mortality in patients with chronic heart failure. This study sought to investigate the diagnostic accuracy and prognostic value of MPO in patients with acute heart failure (AHF). Methods: We prospectively enrolled 667 patients presenting to the emergency department with dyspnea and observed them for 1 year. MPO and B-type natriuretic peptide (BNP) were measured at presentation. Two independent cardiologists adjudicated final discharge diagnoses. Results: MPO concentrations were similar in patients with AHF (n = 377, median 139 pmol/L) and patients with noncardiac causes of dyspnea (n = 290, median 150 pmol/L, P = 0.26). The diagnostic accuracy of MPO for AHF was limited [area under the ROC curve (AUC) 0.53] and inferior to that of BNP (AUC 0.95, P &lt; 0.001). In patients with AHF, MPO concentrations above the lowest tertile (MPO &gt;99 pmol/L) were associated with significantly increased 1-year mortality (hazard ratio 1.58, P = 0.02). The combination of MPO (≤99 vs &gt;99 pmol/L) and BNP (median of ≤847 vs &gt;847 ng/L) improved the prediction of 1-year mortality (hazard ratio 2.80 for both variables increased vs both low, P &lt; 0.001). After adjustment for cardiovascular risk factors in multivariable Cox proportional hazard analysis, increases in MPO contributed significantly toward the prediction of 1-year mortality (hazard ratio 1.51, P = 0.045). Conclusions: MPO is an independent predictor of 1-year mortality in AHF, is additive to BNP, and could be helpful in identifying patients with a favorable prognosis despite increased BNP concentrations.

scholarly journals Utility of plasma galectin-3 in predicting long-term mortality in patients with acute heart failure

2021 ◽  
Vol 8 (4) ◽  
pp. 4306-4314
Author(s):  
Hoang Van Sy ◽  
Dang Quang Toan ◽  
Ta Thi-Thanh Huong ◽  
Chau Ngoc Hoa ◽  
Tran Kim Trang
Keyword(s):  
Heart Failure ◽  
Acute Heart Failure ◽  
Troponin I ◽  
All Cause Mortality ◽  
Galectin 3 ◽  
One Year ◽  
Time Of Admission ◽  
Long Term Mortality

Background: Several studies have investigated Galectin-3 as a promising biomarker for predicting the short-term and long-term mortality of patients with acute heart failure. This study aimed to examine the usefulness of plasma galectin-3 at the time of admission in predicting long-term mortality in Vietnamese patients with acute heart failure (AHF). Methods: We carried out a cohort study including 117 patients consecutively diagnosed with acute heart failure in a single cardiology department. Plasma galectin-3 and other biomarkers were measured at the time of admission. The patient’s clinical and analytical characteristics were recorded. The main endpoint was one-year all-cause mortality. Results: There were six patients (5%) lost to follow-up and 59 patients (53.2%) reaching primary outcome within one year after ‎hospital admission.‎ The median plasma galectin-3 level (ng/mL) in patients with acute heart failure was 34.6 (26.7 – 44.1). Plasma galectin-3 in the alive group was significantly higher than that in the deceased group at one-year follow-up. In predicting one-year all-cause mortality, galectin-3 had an area under the curve (AUC) of 0.71 (95% confidence interval (CI), 0.62 – 0.81) representing a good prognostic factor while brain natriuretic peptide (BNP) and troponin I were inferior to galectin-3 with an AUC of 0.69 (95% CI, 0.59 – 0.79) and 0.63 (95% CI, 0.53 – 0.74), respectively. The optimal cut-off value for galectin-3 was 40.75 ng/mL with a sensitivity of 50.1% and a specificity of 88.5%. In a multivariate model, patients with galectin-3 levels > 40.75 ng/mL had a hazard ratio (HR) of 2.8 (95% CI, 1.5 – 5; p = 0.001). The best prediction model was the combined model of galectin-3 and BNP, yielding an AUC of 0.78 (95% CI, 0.70 – 0.86; p < 0.001). Conclusions: Our study suggested that galectin-3 levels could predict long-term all-cause mortality in patients with acute heart failure with a good prognostic capacity. Combining galectin-3 and BNP could bring up a better risk-stratification.

Abstract 14922: Association of Increase of Serum Albumin Levels During Hospitalization With 1-year Outcomes for Acute Heart Failure

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Takao Kato ◽  
Hidenori Yaku ◽  
Neiko Ozasa ◽  
Erika Yamamoto ◽  
YASUTAKA INUZUKA ◽  
...  
Keyword(s):  
Heart Failure ◽  
Serum Albumin ◽  
Acute Heart Failure ◽  
Primary Outcome ◽  
Primary Outcome Measure ◽  
Proportional Hazard ◽  
Cox Proportional Hazard ◽  
Interaction Interaction ◽  
Primary Composite Outcome

Introduction: Hypoalbuminemia is a well-known prognostic factor in acute heart failure (AHF). Hypothesis: We hypothesized that there is an favorable association of the increase in serum albumin levels during hospitalization with 1-year clinical outcomes in patients hospitalized for AHF. Methods: Using the data of the consecutive 3717 patients hospitalized for AHF and discharged alive in the Kyoto Congestive Heart Failure registry, we evaluated the baseline and therapeutic factors associated with the increase of serum albumin levels during hospitalization for AHF. Next, we compared the effect of increase of albumin for the primary composite outcome measures compromising all-cause death and HF hospitalization using a Cox proportional hazard model. Results: The patients in the increase of albumin group (N=1083, 34%) were younger and less likely to have a larger body mass index and renal dysfunction than those in the non-increase group (N=2077, 66%). Median follow-up was 470 days with 96% 1-year follow-up rate. The risk for the primary outcome measure in the increase group relative to the non-increase group was significantly low (adjusted hazard ratio [HR]: 0.78, 95% confidence interval [CI]: 0.69-0.90: P=0.0004) after adjusting confounders including baseline albumin levels. When stratified by the quartiles of albumin levels at discharge, the trend was more evident in the lower quartiles of albumin levels but without interaction (interaction P=0.38). Conclusions: The increase of albumin was associated with lower 1-year risk for the composite of all-cause death and HF hospitalization in patients with hospitalized AHF, independently of baseline albumin levels.

Do Patients With Acute Heart Failure and Preserved Ejection Fraction Have Heart Failure at Follow-Up: Implications of the Framingham Criteria

2020 ◽  
Vol 26 (8) ◽  
pp. 673-684
Author(s):  
CAMILLA HAGE ◽  
ULRIKA LÖFSTRÖM ◽  
ERWAN DONAL ◽  
EMMANUEL OGER ◽  
AGNIESZKA KAPŁON-CIEŚLICKA ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Acute Heart Failure ◽  
Preserved Ejection Fraction

scholarly journals Histologic Remission Is Associated With Lower Risk of Treatment Failure in Patients With Crohn Disease in Endoscopic Remission

2020 ◽  
Author(s):  
Hyuk Yoon ◽  
Sushrut Jangi ◽  
Parambir S Dulai ◽  
Brigid S Boland ◽  
Vipul Jairath ◽  
...  
Keyword(s):  
Treatment Failure ◽  
Crohn Disease ◽  
Lower Risk ◽  
Hazard Analysis ◽  
Cumulative Risk ◽  
Treatment Optimization ◽  
Cox Proportional Hazard ◽  
Endoscopic Remission ◽  
Risk Of Treatment

Abstract Background Although achieving histologic remission in ulcerative colitis is established, the incremental benefit of achieving histologic remission in patients with Crohn disease (CD) treated to a target of endoscopic remission is unclear. We evaluated the risk of treatment failure in patients with CD in clinical and endoscopic remission by histologic activity status. Methods In a single-center retrospective cohort study, we identified adults with active CD who achieved clinical and endoscopic remission through treatment optimization. We evaluated the risk of treatment failure (composite of clinical flare requiring treatment modification, hospitalization, and/or surgery) in patients who achieved histologic remission vs persistent histologic activity through Cox proportional hazard analysis. Results Of 470 patients with active CD, 260 (55%) achieved clinical and endoscopic remission with treatment optimization; 215 patients with histology were included (median age, 33 years; 46% males). Overall, 132 patients (61%) achieved histologic remission. No baseline demographic, disease, or treatment factor was associated with achieving histologic remission. Over a 2-year follow-up, patients with CD in clinical and endoscopic remission who achieved histologic remission experienced a 43% lower risk of treatment failure (1-year cumulative risk: 12.9% vs 18.2%; adjusted hazard ratio, 0.57 [95% confidence interval, 0.35-0.94]) as compared with persistent histologic activity. Conclusions Approximately 61% of patients with active CD who achieved clinical and endoscopic remission with treatment optimization simultaneously achieved histologic remission, which was associated with a lower risk of treatment failure. Whether histologic remission should be a treatment target in CD requires evaluation in randomized trials.

scholarly journals Short- and Long-term Biologic Variability of Galectin-3 and Other Cardiac Biomarkers in Patients with Stable Heart Failure and Healthy Adults

2016 ◽  
Vol 62 (2) ◽  
pp. 360-366 ◽  
Author(s):  
Emily I Schindler ◽  
Jeffrey J Szymanski ◽  
Karl G Hock ◽  
Edward M Geltman ◽  
Mitchell G Scott
Keyword(s):  
Heart Failure ◽  
Troponin I ◽  
Prognostic Biomarker ◽  
High Sensitivity ◽  
Cardiac Biomarkers ◽  
Healthy Individuals ◽  
Short Term ◽  
Galectin 3 ◽  
Short And Long Term

Abstract BACKGROUND Galectin-3 (Gal-3) has been suggested as a prognostic biomarker in heart failure (HF) patients that may better reflect disease progression than traditional markers, including B-type natriuretic peptide (BNP) and cardiac troponins. To fully establish the utility of any biomarker in HF, its biologic variability must be characterized. METHODS To assess biologic variability, 59 patients were prospectively recruited, including 23 male and 16 female patients with stable HF and 10 male and 10 female healthy individuals. Gal-3, BNP, and high-sensitivity cardiac troponin I (hs-cTnI) were assayed at 5 time points within a 3-week period to assess short-term biologic variability. Long-term (3-month) biologic variability was assessed with samples collected at enrollment and after 4, 8, and 12 weeks. RESULTS Among healthy individuals, mean short-term biologic variability, expressed as intraindividual CV (CVI), was 4.5% for Gal-3, 29.0% for BNP, and 14.5% for hs-cTnI; long-term biologic variability was 5.5% for Gal-3, 34.7% for BNP, and 14.7% for hs-cTnI. In stable HF patients, mean short-term biologic variability was 7.1% for Gal-3, 22.5% for BNP, and 8.5% for hs-cTnI, and mean long-term biologic variability was 7.7% for Gal-3, 27.6% for BNP, and 9.6% for hs-cTnI. CONCLUSIONS The finding that Gal-3 has minimal intraindividual biological variability adds to its potential as a useful biomarker in HF patients.

Abstract 14870: Clinical Significance of Troponin Elevation in a Contemporary Hospitalized Population: Endotypes, Morbidity and In-hospital Mortality

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Michael Briscoe ◽  
Robert A Sykes ◽  
Thomas Krysztofiak ◽  
Kenneth Mangion ◽  
Oliver H Peck ◽  
...  
Keyword(s):  
Clinical Significance ◽  
Myocardial Injury ◽  
Troponin I ◽  
Coronary Revascularization ◽  
High Sensitivity ◽  
Hospitalized Patients ◽  
Troponin Elevation ◽  
Reference Limit ◽  
Upper Reference Limit

Introduction: Unplanned hospitalizations are commonly associated with a circulating troponin concentration >99 th percentile upper reference limit (URL). In order to better understand the clinical significance of troponin elevation, we evaluated outcomes in hospitalized patients according to cardiac endotype. Methods: We prospectively screened consecutive hospitalized patients with elevated high-sensitivity troponin-I (hs-TnI) concentrations (Abbott ARCHITECT troponin-I assay; sex-specific URL, 99 th centile: male: >34ng/L; female: >16ng/L) within a regional cardiac care network (population 650,000). A cardiology clinical team adjudicated individual patient records and assigned endotypes by consensus agreement according to the Fourth Universal Definition of Myocardial Infarction (MI). Endotypes were sub-classified into etiological category by inciting event(s). Characteristics and comorbidity were compared and outcomes recorded on virtual follow-up until June 2 nd 2020. Results: A total of 390 consecutive patients with ≥1 hs-TnI value >URL between March 1-April 15, 2020, were evaluated; 44 patients were excluded ( Duplicates: 2; Missing data: 41; Research patient: 1 ). Of 346 who qualified for inclusion, an index diagnosis of Type 1 MI (T1MI), T2MI and myocardial injury were assigned in 115 (33.2%), 79 (22.8%) and 152 (43.9%) patients, respectively. Compared with T1MI, patients with T2MI and myocardial injury had lower peak hs-TnI values (median [IQR]: 86 [250-697] vs 5020 [853-7774]ng/L; p< 0.01), lower estimated 10-year survival (40.2% vs 53.4%; p=0.002), less frequently underwent coronary revascularization (1.4% vs 45.2%; p<0.0005) and had longer inpatient stay (13.0 vs 6.1 days). Inpatient and overall mortality rates from admission to follow-up (median [range]: 71 [0-151] days) were higher among patients with T2MI and myocardial injury (19.9% vs 7.8%; p=0.004; and 26.0% vs 11.3%; Log rank (Mantel-Cox) X 2 = 1.927; p=0.003) independent of similar cardiovascular risk profiles. Conclusions: Despite lower peak circulating troponin concentrations, patients with T2MI and myocardial injury had higher inpatient mortality, lower estimated 10-year survival and longer in-hospital stay compared to those with T1MI.

scholarly journals N-terminal Pro-brain Natriuretic Peptide plasma levels are Associated With a Short-Term Diagnosis of Cancer in Patients with Coronary Artery Disease

2020 ◽  
Author(s):  
José Tuñón ◽  
Álvaro Aceña ◽  
Ana Pello ◽  
Sergio Ramos-Cillán ◽  
Juan Martínez-Milla ◽  
...  
Keyword(s):  
Heart Failure ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Brain Natriuretic Peptide ◽  
Natriuretic Peptide ◽  
Plasma Levels ◽  
High Sensitivity ◽  
Short Term ◽  
Artery Disease

Abstract Background N-terminal pro-brain natriuretic peptide (NT-proBNP) plasma levels are increased in patients with cancer. In this paper we test whether NT-proBNP may identify patients who are going to receive a future cancer diagnosis (CD) in the short term. Methods We studied 962 patients with stable coronary artery disease and free of cancer and heart failure at baseline. NT-proBNP, galectin-3, monocyte chemoattractant protein-1, high-sensitivity C-reactive protein, high-sensitivity cardiac troponin I (hsTnI), and calcidiol (vitamin D) plasma levels were assessed. The primary outcome was new CD. Results After 5.40 (2.81-6.94) years of follow-up, 59 patients received a CD. NT-proBNP [HR 1.036 CI (1.015-1.056) per increase in 100 pg/ml; p=0.001], previous atrial fibrillation [HR 3.140 CI (1.196-8.243); p=0.020], and absence of previous heart failure [HR 0.067 CI (0.006-0.802); p=0.033] were independent predictors of a receiving a CD in first three years of follow-up. None of the variables analyzed predicted a CD beyond this time. A previous history of heart failure was present in 3.3% of patients receiving a CD in the first three years of follow-up, in 0.0% of those receiving this diagnosis beyond three years, and in 12.3% of patients not developing cancer (p=0.036). Conclusions In patients with coronary artery disease, NT-proBNP is an independent predictor of CD in the first three years of follow-up but not later, suggesting that it could be detecting subclinical undiagnosed cancers. The existence of previous heart failure does not account for these differences. New studies in large populations are needed to confirm these findings.

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