Division of Cardiology Mitsui Memorial Hospital Tokyo Japan.
Division of Cardiovascular Medicine University of California, San Diego La Jolla CA.
J Am Heart Assoc. 2024 Sep 17;13(18):e034850. doi: 10.1161/JAHA.124.034850. Epub 2024 Sep 9.
Higher cardiac troponin is associated with worse outcomes in patients with acute heart failure. The significance of repeat measurements over hours remains unclear. We assessed whether a repeat measurement and the Δ between measurements of high-sensitivity cardiac troponin I (hs-cTnI) were associated with outcomes in hypervolemic patients with acute heart failure without acute coronary syndrome.
We analyzed 582 individuals from AKINESIS (Acute Kidney Injury Neutrophil Gelatinase-Associated Lipocalin Evaluation of Symptomatic Heart Failure Study) with hs-cTnI measured ≤12 hours from admission and repeated ≤6 hours thereafter. Associations between hs-cTnI levels and their Δ with short-term (death, intensive care unit admission, receipt of inotropes, or positive pressure ventilation during hospitalization) and long-term (death or heart failure readmission within 1 year) outcomes were assessed. The average age was 69±13 years, 62% were men, 65% were White, 46% had coronary artery disease, and 22% had chest pain. Median hs-cTnI levels were 27 (interquartile range [IQR], 13-62) ng/L initially and 28 (IQR, 14-68) ng/L subsequently, with a Δ of 0 [IQR, -2 to 4] ng/L over 3.4±1 hours. Only the second measurement was associated with short-term outcomes (odds ratio, 1.14 per 2-fold higher [95% CI, 1.02-1.28]). Both individual measurements and the Δ were associated with long-term outcomes (hazard ratios, 1.09, 1.12, and 1.16 for first, second, and Δ, respectively). Associated risk for the first and second measurements were not constant over the year but highest early after being measured and decreased over 1 year.
Repeat measurements of hs-cTnI over hours can identify individuals with acute heart failure without acute coronary syndrome at risk for short- and long-term outcomes.
高心脏肌钙蛋白与急性心力衰竭患者的预后不良相关。数小时内重复测量的意义仍不清楚。我们评估了在没有急性冠状动脉综合征的急性心力衰竭伴高血容量患者中，高敏心肌肌钙蛋白 I（hs-cTnI）的重复测量值及其测量值之间的 Δ是否与结局相关。
我们分析了来自 AKINESIS（急性肾损伤中性粒细胞明胶酶相关脂质运载蛋白评估有症状心力衰竭研究）的 582 名个体，hs-cTnI 在入院后≤12 小时内测量，并在此后≤6 小时内重复测量。评估 hs-cTnI 水平及其 Δ与短期（住院期间死亡、入住重症监护病房、使用正性肌力药物或正压通气）和长期（1 年内死亡或心力衰竭再入院）结局之间的关系。平均年龄为 69±13 岁，62%为男性，65%为白人，46%有冠状动脉疾病，22%有胸痛。初始时 hs-cTnI 中位数为 27（四分位距 [IQR]，13-62）ng/L，随后为 28（IQR，14-68）ng/L，3.4±1 小时后 Δ为 0 [IQR，-2 至 4] ng/L。只有第二次测量与短期结局相关（优势比，每 2 倍升高 1.14[95%CI，1.02-1.28]）。单次测量值和 Δ均与长期结局相关（首次、第二次和 Δ的危险比分别为 1.09、1.12 和 1.16）。首次和第二次测量的相关风险在 1 年内并不稳定，但在测量后早期最高，并在 1 年内逐渐降低。
数小时内重复测量 hs-cTnI 可以识别没有急性冠状动脉综合征的急性心力衰竭患者，这些患者存在短期和长期结局的风险。
