High-Sensitivity Cardiac Troponin T Predicts Non-Cardiac Mortality in Heart Failure

Nakamura, Yūichi; Yoshihisa, Akiomi; Takiguchi, Masafumi; Shimizu, Takeshi; Iwaya, Shoji; Owada, Takashi; Miyata, Makiko; Abe, Satoshi; Sato, Toshio; Suzuki, Satoshi; Oikawa, Masayoshi; Kobayashi, Atsushi; Yamaki, Takashi; Sugimoto, Koichi; Kunii, Hiroyuki; Nakazato, Kazuhiko; Suzuki, Hitoshi; Saitoh, Shu‐ichi; Takeishi, Yasuchika

doi:10.1253/circj.cj-13-1372

Cited by 34 publications

(24 citation statements)

References 38 publications

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“…We firstly found that the circulating levels of melatonin in the DCM patients were significantly lower than in the control subjects and that plasma melatonin was significantly correlated with serum troponin T levels in the DCM patients. These data suggest that the patients with lower circulating levels of melatonin had more myocardial degeneration, because the elevation in circulating cardiac troponin T levels indicates ongoing myocardial injury in the heart failure patients . Growing evidence demonstrates that melatonin has a protective effect on cells.…”

Section: Discussionmentioning

confidence: 91%

“…Serum BNP levels were measured using a specific immunoradiometric assay (Shionoria BNP kit, Shionogi, Osaka, Japan). High‐sensitivity cardiac troponin T levels were measured using an electrochemiluminescence immunoassay (Elecsys Troponin T hs, Roche Diagnostics Ltd., Rotkreuz, Switzerland) . These assays were performed by experienced laboratory technicians blinded to this study.…”

Section: Methodsmentioning

confidence: 99%

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Plasma levels of melatonin in dilated cardiomyopathy

Misaka

Yoshihisa

Yokokawa

et al. 2019

Journal of Pineal Research

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Background Melatonin is a multifunctional indolamine and has a cardioprotective role in a variety of cardiovascular processes via antioxidant, anti‐inflammatory, antihypertensive, antithrombotic, and antilipemic effects. It has been reported that lower levels of circulating melatonin are significantly associated with a higher risk of acute myocardial infarction (AMI) and later cardiac remodeling. However, levels of melatonin in patients with dilated cardiomyopathy (DCM) and associations between melatonin levels and cardiac function remain unclear. Methods and Results We measured and compared plasma levels of melatonin in 61 control subjects, 81 AMI patients, and 77 DCM patients. Plasma levels of melatonin were progressively decreased from 71.9 pg/mL in the control group to 52.6 pg/mL in the DCM group and 21.9 pg/mL in the AMI group. Next, we examined associations of melatonin levels with parameters of laboratory data, echocardiography, and right‐heart catheterization. In the DCM patients, circulating melatonin showed significant correlations with both high‐sensitivity troponin T ( R = −0.422, P < 0.001) and cardiac output ( R = 0.431, P = 0.003), but not with B‐type natriuretic peptide (BNP), left ventricular ejection fraction (LVEF), pulmonary artery wedge pressure, or pulmonary artery pressure. Conclusion Patients with not only AMI but also DCM had lower circulating melatonin levels. Circulating melatonin levels appear to correlate with myocardial injury and cardiac output in DCM patients.

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Section: Discussionmentioning

confidence: 91%

Section: Methodsmentioning

confidence: 99%

Plasma levels of melatonin in dilated cardiomyopathy

Misaka

Yoshihisa

Yokokawa

et al. 2019

Journal of Pineal Research

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“…Long‐term clinical outcome was assessed in 7 studies . The meta‐analysis of 6 studies demonstrated an increase in mortality without significant heterogeneity (OR: 3.69, 95% CI: 2.64‐5.18, P = 0.696, I 2 0.0%, 6 studies, n = 1891) among ADHF patients with a detectable or elevated cTn.…”

Section: Resultsmentioning

confidence: 99%

Cardiac troponin in patients hospitalized with acute decompensated heart failure: A systematic review and meta‐analysis

Yousufuddin

Abdalrhim

Wang

et al. 2016

Journal of Hospital Medicine

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BACKGROUND Elevated cardiac troponin (cTn) is often observed in patients with acute decompensated heart failure (ADHF). We assessed the magnitude of association and quality of supporting evidence between cTn and clinically important outcomes in persons hospitalized for ADHF. METHODS We searched MEDLINE In‐Process & Other Non‐Indexed Citations, MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Scopus from inception through February 28, 2015. The outcomes analyzed included hospital length of stay (LOS), readmissions, and mortality. Random effects meta‐analysis was used to combine outcomes across studies. RESULTS We included 26 clinical studies. A detectable or elevated cTn was associated with increased LOS (odds ratio [OR]: 1.05; 95% confidence interval [CI]: 1.01‐1.10), increased in‐hospital mortality (OR: 2.57; 95% CI: 2.27‐2.91), and a composite of mortality and major adverse events (OR: 1.33; 95% CI: 1.03‐1.71) during hospitalization. ADHF patients with a detectable or elevated cTn were at increased risk for mortality and composite of mortality and readmission over the short term (mortality OR: 2.11; 95% CI: 1.43‐3.12; composite OR: 2.81; 95% CI: 1.60‐4.92), intermediate term (mortality OR: 2.21; 95% CI: 1.46‐3.35; composite OR: 2.30; 95% CI: 1.78‐2.99), and long term (mortality OR: 3.69; 95% CI: 2.64‐5.18; composite OR: 3.49; 95% CI: 2.08‐5.84). The overall confidence in estimates was moderate. CONCLUSIONS Among ADHF patients, a detectable or elevated cTn identifies subjects at increased risk for adverse clinical outcomes during acute hospitalization and those at higher risk for postdischarge mortality and composite of readmission and mortality. Journal of Hospital Medicine 2016;11:446–454. 2016 Society of Hospital Medicine

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“…21-22, 24 Recent studies with high-sensitivity troponin have further found that cTnT is an independent predictor not only for cardiac mortality, but also for non-cardiac mortality. 25 Our findings demonstrate that more than half of the deaths in the first year after ICD implantation were due to a cardiac cause, primarily pump failure. Findings from our study suggest that inflammation, neurohumoral modulation, and cardiac injury may be associated with the progression of heart failure and can improve risk prediction for early mortality beyond traditional clinical risk factors.…”

Section: Discussionmentioning

confidence: 63%

Clinical and serum-based markers are associated with death within 1 year of de novo implant in primary prevention ICD recipients

et al. 2015

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Background Implantable cardioverter defibrillator (ICD) implantation is contraindicated in those with <1 year life expectancy. Objective To develop a risk prediction score for 1-year mortality in patients with primary prevention ICDs and to determine the incremental improvement in discrimination when incorporating serum-based biomarkers to traditional clinical variables. Methods We analyzed data from the PROSE-ICD study, a large prospective observational study of patients undergoing primary prevention ICD implantation who were extensively phenotyped for clinical and serum markers. We identified variables predicting 1-year mortality and synthesized them into a comprehensive risk scoring construct using backward selection. Results Among 1,189 patients deemed by their treating physicians as having reasonable 1 year life expectancy, 62 patients died within 1 year of ICD implantation. The risk score, comprised of 6 clinical factors (age ≥75 years, New York Heart Association class III/IV, atrial fibrillation, eGFR <30mL/min/1.73m2, diabetes, and use of diuretics), had good discrimination (AUC=0.77) for 1-year mortality. Addition of 3 biomarkers (TNF-αRII, pro-BNP, and cTnT) further improved model discrimination to 0.82. Patients with 0-1, 2-3, 4-6, or 7-9 risk factors had 1-year mortality rates of 0.8%, 2.7%, 16.1% and 46.2%, respectively. Conclusions Individuals with more co-morbidities and elevations of specific serum biomarkers were at increased risk for all-cause mortality despite being deemed as having reasonable 1 year life expectancy. A simple risk score comprised of readily available clinical data and serum biomarkers may better identify patients at high risk of early mortality and improve patient selection and counseling for primary prevention ICD therapy.

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High-Sensitivity Cardiac Troponin T Predicts Non-Cardiac Mortality in Heart Failure

Cited by 34 publications

References 38 publications

Plasma levels of melatonin in dilated cardiomyopathy

Plasma levels of melatonin in dilated cardiomyopathy

Cardiac troponin in patients hospitalized with acute decompensated heart failure: A systematic review and meta‐analysis

Clinical and serum-based markers are associated with death within 1 year of de novo implant in primary prevention ICD recipients

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