Cardiac troponin T levels are associated with poor short- and long-term prognosis in patients with acute cardiogenic pulmonary edema

Perna, Eduardo R.; Macı́n, Stella M.; Parras, Jorge I.; Pantich, Rolando; Farías, Eduardo; Badaracco, Jorge R.; Jantus, Eloise; Medina, Fernanda; Brizuela, Mónica

doi:10.1067/mhj.2002.120152

Cited by 76 publications

(60 citation statements)

References 34 publications

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“…10,24 A study of patients with acute cardiogenic pulmonary edema found a correlation between serum cTnI levels and markers of sympathetic nervous system activation. 25 In our cohort of patients with advanced HF, elevation of cTnI was associated with significantly decreased albumin and HDL, findings associated with systemic cytokine activation and catabolic state. 26…”

Section: Discussionmentioning

confidence: 98%

Cardiac Troponin I Is Associated With Impaired Hemodynamics, Progressive Left Ventricular Dysfunction, and Increased Mortality Rates in Advanced Heart Failure

et al. 2003

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Background-Cardiac troponin I (cTnI), a sensitive and specific marker of myocardial cell injury, is useful in diagnosing and assessing prognosis in acute coronary syndromes. Small studies report that cTnI is elevated in severe heart failure (HF) and may predict adverse outcomes. Methods and Results-The present study evaluated 238 patients with advanced HF referred for cardiac transplantation evaluation who had cTnI assay drawn at the time of initial presentation. Patients with acute myocardial infarction or myocarditis were excluded from analysis. cTnI was detectable (cTnI Ն0.04 ng/mL) in serum of 117 patients (49.1%).Patients with detectable cTnI levels had significantly higher B-type natriuretic peptide (BNP) levels (PϽ0.001) and more impaired hemodynamic profiles, including higher pulmonary wedge pressures (Pϭ0.002) and lower cardiac indexes (PϽ0.0001). A significant correlation was found between detectable cTnI and progressive decline in ejection fraction over time. Furthermore, detectable cTnI was associated with increased mortality risk (RR, 2.05; 95% CI, 1.22 to 3.43). After adjustment for other factors associated with adverse prognosis including age, sex, ejection fraction, and coronary artery disease, cTnI remained a significant predictor of death. cTnI used in conjunction with BNP further improved prognostic value. Conclusions-cTnI is associated with impaired hemodynamics, elevated BNP levels, and progressive left ventricular dysfunction in patients with HF. cTnI may be a novel, useful tool in identifying patients with HF who are at increased risk for progressive ventricular dysfunction and death.

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Section: Discussionmentioning

confidence: 98%

Cardiac Troponin I Is Associated With Impaired Hemodynamics, Progressive Left Ventricular Dysfunction, and Increased Mortality Rates in Advanced Heart Failure

et al. 2003

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“…14,16,17,21,22 Conversely, the presence of troponin in decompensated CHF was also associated with more profound clinical and hemodynamic deterioration, more severe LV remodeling, and worse short-and long-term prognosis. 15,[23][24][25][26][27] Combining cTnT and brain natriuretic peptide (BNP) offers a new risk-stratifying tool that detects cellular injury as well as ventricular overload. 26 In contrast, data pertaining to the monitoring of serial cTnT concentrations are scarce.…”

Section: Discussionmentioning

confidence: 99%

“…Under these new conditions, the marker may increase further, as has been described in patients with acute pulmo- nary edema, in whom it is difficult to distinguish between troponin increases from CHF versus from true myocardial infarction. 15 …”

Section: Prognostic Role Of Ctnt Monitoringmentioning

confidence: 99%

“…Their introduction into clinical practice has changed the perception and definition of myocardial infarction, 11,12 and they are currently the object of extensive research in patients with CHF. [13][14][15][16][17] We hypothesized that the leak of cTnT during the stable phase of CHF may be a sign of ongoing subclinical progression of CHF. This study (1) examined the prevalence of increased concentrations of cTnT in serial blood samples collected from ambulatory patients with CHF and (2) tested the hypothesis that persistently increased concentrations of cTnT in these patients are associated with a worse long-term outcome.…”

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confidence: 99%

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Ongoing Myocardial Injury in Stable Severe Heart Failure

Perna¹,

Macin²,

Canella³

et al. 2004

Circulation

126

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Background-The progression of chronic heart failure (CHF) is related to ongoing myocyte loss, which can be detected by cardiac troponin T (cTnT). We examined the prevalence and prognostic value of increased cTnT concentrations in serial blood specimens from patients with severe CHF. Methods and Results-Clinical, echocardiographic, and 6-minute walk test data were collected prospectively at baseline and at 1 year in 115 outpatients (mean age, 61Ϯ11 years; 75% men; 62% coronary heart disease) with CHF and a left ventricular ejection fraction Ͻ40%. Blood samples were collected at baseline and at 3, 6, and 12 months of follow-up. cTnT concentrations Ն0.02 ng/mL were considered abnormal, and a Tn index (highest cTnT measurement/0.02 ng/mL) was calculated. In 62 patients (54%), cTnT was consistently Ͻ0.02 ng/mL (group 1); 28 (24%) had a single abnormal cTnT result (group 2); and 25 (22%) had Ն2 abnormal cTnT results (group 3). At 18 months, CHF hospitalization-free survival was 63%, 46%, and 17%, respectively (Pϭ0.0001). In a Cox proportional-hazards model, hospitalization for worsening CHF in the previous year (HRϭ2.1; 95% CI, 1.1 to 4.1), functional class III-IV (HRϭ2.3; 95% CI, 1.1 to 4.6), and number of abnormal cTnT samples (HRϭ1.6; 95% CI, 1.1 to 2.4) were independently associated with prognosis. A cTnT rise of 0.020 ng/mL in any sample was associated with an excess of 9% (95% CI, 1% to 18%) in the incidence of combined end point. Conclusions-Abnormal cTnT concentrations were detected in Ͼ50% of outpatients with advanced CHF. This ongoing myocardial necrosis was a strong predictor of worsening CHF, suggesting a role of cTnT-based monitoring to identify high-risk patients.

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“…13 In heart failure patients, elevated troponin is associated with the risk of death and rehospitalization regardless of underlying cause and the three-year survival is about 29%. 14,15 Critically ill patients who require stay in an intensive care unit are a heterogeneous group of patients who are ill for a variety of heterogeneous diseases. Thus, estimation of cardiac troponins and their significance in these patients are heterogeneous.…”

Section: Discussionmentioning

confidence: 99%

Study of troponin-t elevation in critically ill patients-incidence and outcome

et al. 2017

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Background: Besides cardiac disease, critical illness patients are often subjected to myocardial injury. Hence, the goal of present study was to analyze the incidence of elevated cardiac troponin levels in critically ill patients and its outcome which in turn can act as a prognostic marker.Methods: The settings were the ICU’s of a tertiary care hospital in south India. A sample of 54 was identified using purposive sampling technique. Serial monitoring of troponin T was done on day 1, 3 and 5. A performa was used to collect the baseline data of who met the inclusion and exclusion criteria. The collected data was analyzed by using descriptive and inferential statistics.Results: Among 54 patients 17 (31.5%) of them expired. It was found that patients with mean APACHE score were significantly greater among mortality group (P<0.001). When analyzing the outcome in relation to the troponin T levels, it can be concluded that troponin levels were higher among patients who died but it was not statistically significant. (p=0.56, 0.84 and 0.67 on day 1, 3 and 5 respectively). Among the 54 patients it is inferred from the findings that most of the critically ill patients do have high troponin T levels.Conclusions: The study illustrated the incidence of high troponin T levels in critically ill patients which is an informative prognostic indicator. The relation couldn’t be proved due to less sample size and other imposing factors in critically ill such as broad diagnostic categories.

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Cardiac troponin T levels are associated with poor short- and long-term prognosis in patients with acute cardiogenic pulmonary edema

Cited by 76 publications

References 34 publications

Cardiac Troponin I Is Associated With Impaired Hemodynamics, Progressive Left Ventricular Dysfunction, and Increased Mortality Rates in Advanced Heart Failure

Cardiac Troponin I Is Associated With Impaired Hemodynamics, Progressive Left Ventricular Dysfunction, and Increased Mortality Rates in Advanced Heart Failure

Ongoing Myocardial Injury in Stable Severe Heart Failure

Study of troponin-t elevation in critically ill patients-incidence and outcome

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