Risk stratification using a combination of cardiac troponin T and brain natriuretic peptide in patients hospitalized for worsening chronic heart failure

Ishii, Junnichi; Nomura, Masatoshi; Nakamura, Yoriyuki; Naruse, Hiroyuki; Mori, Yoshihide; Ishikawa, Takashi; Ando, Tatsuya; Kurokawa, Hiroshi; Kondo, Takeshi; Nagamura, Yoichi; K, Ezaki; Hishida, Hitoshi

doi:10.1016/s0002-9149(01)02341-4

Cited by 167 publications

(128 citation statements)

References 11 publications

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“…3,5,38) However, most studies of the prognostic value of cTnT in acute coronary syndrome, chronic heart failure and pulmonary embolism have found that the cTnT level at a single point is an independent predictor of future cardiac events. 2,4,[6][7][8]20,39) The rate of cTnT detected by the assay in the present study is very low in healthy adults. 17) Thus, we believe that elevated cTnT even at a single point has clinical significance.…”

Section: Therapeutic Implications Of Ongoing Myocardial Damage In Hy-contrasting

confidence: 48%

“…cTnT is a sensitive marker for the detection of myocardial damage in patients with not only acute coronary syndrome but also with chronic heart failure [2][3][4][5][6][7][8] and pulmonary embolism. 20) Therefore, some hypertensive patients might have ongoing myocardial damage.…”

Section: Discussionmentioning

confidence: 99%

“…Recent studies including ours have shown that ongoing myocardial damage detected as elevated cTnT levels can discriminate patients with chronic heart failure (CHF) at increased risk for future cardiac events. [2][3][4][5][6][7][8] HT is an important precursor of heart failure. Several experimental studies have shown that myocardial damage or apoptotic cardiomyocytes are associated with HT.…”

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confidence: 99%

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Elevated Cardiac Troponin T Predicts Adverse Outcomes in Hypertensive Patients

et al. 2011

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SummaryOngoing myocardial damage detected as elevated serum cardiac troponin T (cTnT) indicates increased risk for future cardiac events in patients with chronic heart failure. Whether elevated cTnT is associated with adverse outcomes in patients with hypertension (HT) without left ventricular (LV) systolic dysfunction is unknown.We measured cTnT levels in 176 patients with essential HT without LV systolic dysfunction (LV ejection fraction ≤ 55%), renal failure, and prior cardiovascular or cerebrovascular diseases and 39 normal controls. Levels of cTnT were elevated ( ≥ 0.02 ng/mL) in 15 (9%) of the 176 patients and in 0 (0%) of the 39 normal controls (P = 0.04). The rate of diabetes mellitus (DM), the cardiothoracic ratio, plasma B-type natriuretic peptide (BNP) value, and LV mass index were significantly higher in patients with than without elevated cTnT (DM, 8/15 versus 29/161, P = 0.004; cardiothoracic ratio, 54.5 ± 4.5 versus 51.6 ± 5.2%, P = 0.04; BNP, 103.3 ± 142.3 versus 36.9 ± 50.7 pg/mL, P = 0.04; LV mass index, 227 ± 87 versus 152 ± 57 g/m 2 , P = 0.0001). Kaplan-Meier analysis demonstrated that significantly fewer (P < 0.000001) patients with, than without elevated cTnT remained free of events (hospitalization due to cardiovascular or cerebrovascular disease, n = 34). Stepwise Cox multivariate analysis revealed that elevated cTnT (hazard ratio, 6.58; P = 0.000001) and smoking (hazard ratio, 2.24; P = 0.04) were independent predictors of events.The present findings indicate that cTnT is a novel and useful predictor of future cardiovascular or cerebrovascular events in hypertensive patients. (Int Heart J 2011; 52: 164-169)

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Section: Therapeutic Implications Of Ongoing Myocardial Damage In Hy-contrasting

confidence: 48%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Elevated Cardiac Troponin T Predicts Adverse Outcomes in Hypertensive Patients

et al. 2011

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“…2 A study of 98 patients hospitalized with class III and IV HF found that a cTnT level Ͼ0.033 g/L on admission was associated with an increased risk of cardiac death. 27 In our cohort, the prognostic power of cTnI appeared to be additive to other predictors of death in HF. The combination of elevated cTnI and elevated BNP identified patients with HF with a markedly increased risk of death (12-fold increase); this multimarker approach to risk stratification is similar to recent observations in patients with acute coronary syndromes in which cTnI, BNP, and C-reactive protein provided additive prognostic information.…”

Section: Troponins and Risk Stratificationmentioning

confidence: 54%

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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“…The risk of adverse outcomes, including death, is normally related to underlying disease severity. 23,24 In the current evaluation, patients in the lowest quartile of PCWP had higher mean cardiac output with lower mean systemic vascular resistance and right atrial pressure than the patients in the other 3 PCWP quartiles combined, suggesting that patients in the lowest PCWP quartile had less severe heart failure. Despite this, many of these patients received HDDs and administration of HDDs significantly increased the risks of hypotension, acute SCr elevation, and death for patients in this quartile.…”

Section: Resultsmentioning

confidence: 58%

Hemodynamics, Diuretics, and Nesiritide: A Retrospective VMAC Analysis

Young

Cheng

Mills

2009

Clinical Cardiology

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Hypothesis: Hypotension has been proposed as the cause of nesiritide-associated increases in serum creatinine (SCr); however, this hypothesis has not been tested. Methods: This retrospective evaluation of patients who had a pulmonary artery catheter and received nesiritide in the Vasodilation in the Management of Acute Congestive Heart Failure (VMAC) trial assessed hypotension, SCr elevation, concomitant therapy, and mortality. Patients were categorized by baseline pulmonary capillary wedge pressure (PCWP) and analyzed both for overall population and by diuretic dose. Results: Compared with patients with PCWP >23 mm Hg (n = 105), patients with PCWP ≤23 mm Hg (n = 49) had more hypotension within 24 hours of initiating nesiritide (16% vs 7%), but neither more SCr elevation by nominal day 30 (29% vs 28%) nor higher mortality (30 days: 8.2% vs 7.7%; 6 months: 29.0% vs 29.3%). The risk of hypotension was directly related to high dose diuretics (25% vs 6%; relative risk [RR]: 4.2; 95% confidence interval [CI]: 1.10-15.82) and was not significantly increased in patients without this concomitant treatment (10% vs 7%; RR: 1.4; 95% CI: 0.34-5.93). Additionally, high dose diuretics significantly increased the risk of SCr elevation (RR: 2.6; 95% CI: 1.03-6.64) and 6 month mortality (hazard ratio: 3.6; 95% CI: 1.19-10.63) in patients with PCWP ≤23 mm Hg. Conclusions: Hypotension is not the primary etiology for nesiritide-associated increases in SCr. High dose diuretics increase the risk of adverse outcomes in patients with PCWP ≤23 mm Hg and should be reserved for patients in whom PCWPs are known to be markedly elevated.

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Risk stratification using a combination of cardiac troponin T and brain natriuretic peptide in patients hospitalized for worsening chronic heart failure

Cited by 167 publications

References 11 publications

Elevated Cardiac Troponin T Predicts Adverse Outcomes in Hypertensive Patients

Elevated Cardiac Troponin T Predicts Adverse Outcomes in Hypertensive Patients

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

Hemodynamics, Diuretics, and Nesiritide: A Retrospective VMAC Analysis

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