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High‐Sensitivity Troponin I in Hospitalized and Ambulatory Patients With Heart Failure With Preserved Ejection Fraction: Insights From the Heart Failure Clinical Research Network

BACKGROUND: We sought to study the prevalence of high‐sensitivity troponin and its association with cardiac structure and outcomes in ambulatory and hospitalized patients with heart failure with a preserved ejection fraction (HFpEF). METHODS AND RESULTS: A post hoc analysis utilized data from HFpEF...

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Autores principales: Fudim, Marat, Ambrosy, Andrew P., Sun, Jie‐Lena, Anstrom, Kevin J., Bart, Bradley A., Butler, Javed, AbouEzzeddine, Omar, Greene, Stephen J., Mentz, Robert J., Redfield, Margaret M., Reddy, Yogesh N.V., Vaduganathan, Muthiah, Braunwald, Eugene, Hernandez, Adrian F., Borlaug, Barry A., Felker, G. Michael
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6405612/
https://www.ncbi.nlm.nih.gov/pubmed/30561266
http://dx.doi.org/10.1161/JAHA.118.010364
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author Fudim, Marat
Ambrosy, Andrew P.
Sun, Jie‐Lena
Anstrom, Kevin J.
Bart, Bradley A.
Butler, Javed
AbouEzzeddine, Omar
Greene, Stephen J.
Mentz, Robert J.
Redfield, Margaret M.
Reddy, Yogesh N.V.
Vaduganathan, Muthiah
Braunwald, Eugene
Hernandez, Adrian F.
Borlaug, Barry A.
Felker, G. Michael
author_facet Fudim, Marat
Ambrosy, Andrew P.
Sun, Jie‐Lena
Anstrom, Kevin J.
Bart, Bradley A.
Butler, Javed
AbouEzzeddine, Omar
Greene, Stephen J.
Mentz, Robert J.
Redfield, Margaret M.
Reddy, Yogesh N.V.
Vaduganathan, Muthiah
Braunwald, Eugene
Hernandez, Adrian F.
Borlaug, Barry A.
Felker, G. Michael
author_sort Fudim, Marat
collection PubMed
description BACKGROUND: We sought to study the prevalence of high‐sensitivity troponin and its association with cardiac structure and outcomes in ambulatory and hospitalized patients with heart failure with a preserved ejection fraction (HFpEF). METHODS AND RESULTS: A post hoc analysis utilized data from HFpEF patients: DOSE (Diuretic Optimization Strategies Evaluation) and CARRESS‐HF (Cardiorenal Rescue Study in Acute Decompensated Heart Failure) enrolled patients hospitalized with acute HFpEF, and RELAX (Phosphodiesterase‐5 Inhibition to Improve Clinical Status and Exercise Capacity in Heart Failure With Preserved Ejection Fraction) enrolled ambulatory patients with HFpEF. High‐sensitivity troponin I (hs‐TnI) was measured in hospitalized patients at baseline, at 72 to 96 hours, on day 7, and on day 60. In ambulatory patients hs‐TnI was measured at baseline and at week 24. In the ambulatory cohort, correlations between hs‐TnI and cardiac structure and function were assessed. The association between hs‐TnI and a 60‐day composite of emergency room visits, readmissions, and death was assessed for hospitalized patients using multivariable Cox proportional hazard models. The study population included 139 hospitalized and 212 ambulatory patients with HFpEF and hs‐TnI measured at baseline. The median (25th, 75th percentiles) baseline troponin was 17.6 (11.1, 41.0) ng/L in hospitalized patients and 9.5 (5.3, 19.7) ng/L in ambulatory patients (P<0.001). The prevalence of elevated hs‐TnI (>99% percentile upper reference limit was 86% in hospitalized patients and 53% among ambulatory patients, with stable elevation in ambulatory patients during follow‐up. HFpEF patients with a hs‐TnI above the median were older with worse left ventricular hypertrophy and diastolic dysfunction. Continuously valued hs‐TnI (per doubling) was associated with increased risk of composite end point (adjusted hazard ratio 1.20, 95% confidence interval 1.00‐1.43; P=0.042). CONCLUSIONS: Hs‐TnI is commonly elevated among both hospitalized and ambulatory patients with HFpEF. Increased hs‐TnI levels are associated with worse cardiac structure and increased risk of adverse events.
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spelling pubmed-64056122019-03-19 High‐Sensitivity Troponin I in Hospitalized and Ambulatory Patients With Heart Failure With Preserved Ejection Fraction: Insights From the Heart Failure Clinical Research Network Fudim, Marat Ambrosy, Andrew P. Sun, Jie‐Lena Anstrom, Kevin J. Bart, Bradley A. Butler, Javed AbouEzzeddine, Omar Greene, Stephen J. Mentz, Robert J. Redfield, Margaret M. Reddy, Yogesh N.V. Vaduganathan, Muthiah Braunwald, Eugene Hernandez, Adrian F. Borlaug, Barry A. Felker, G. Michael J Am Heart Assoc Original Research BACKGROUND: We sought to study the prevalence of high‐sensitivity troponin and its association with cardiac structure and outcomes in ambulatory and hospitalized patients with heart failure with a preserved ejection fraction (HFpEF). METHODS AND RESULTS: A post hoc analysis utilized data from HFpEF patients: DOSE (Diuretic Optimization Strategies Evaluation) and CARRESS‐HF (Cardiorenal Rescue Study in Acute Decompensated Heart Failure) enrolled patients hospitalized with acute HFpEF, and RELAX (Phosphodiesterase‐5 Inhibition to Improve Clinical Status and Exercise Capacity in Heart Failure With Preserved Ejection Fraction) enrolled ambulatory patients with HFpEF. High‐sensitivity troponin I (hs‐TnI) was measured in hospitalized patients at baseline, at 72 to 96 hours, on day 7, and on day 60. In ambulatory patients hs‐TnI was measured at baseline and at week 24. In the ambulatory cohort, correlations between hs‐TnI and cardiac structure and function were assessed. The association between hs‐TnI and a 60‐day composite of emergency room visits, readmissions, and death was assessed for hospitalized patients using multivariable Cox proportional hazard models. The study population included 139 hospitalized and 212 ambulatory patients with HFpEF and hs‐TnI measured at baseline. The median (25th, 75th percentiles) baseline troponin was 17.6 (11.1, 41.0) ng/L in hospitalized patients and 9.5 (5.3, 19.7) ng/L in ambulatory patients (P<0.001). The prevalence of elevated hs‐TnI (>99% percentile upper reference limit was 86% in hospitalized patients and 53% among ambulatory patients, with stable elevation in ambulatory patients during follow‐up. HFpEF patients with a hs‐TnI above the median were older with worse left ventricular hypertrophy and diastolic dysfunction. Continuously valued hs‐TnI (per doubling) was associated with increased risk of composite end point (adjusted hazard ratio 1.20, 95% confidence interval 1.00‐1.43; P=0.042). CONCLUSIONS: Hs‐TnI is commonly elevated among both hospitalized and ambulatory patients with HFpEF. Increased hs‐TnI levels are associated with worse cardiac structure and increased risk of adverse events. John Wiley and Sons Inc. 2018-12-07 /pmc/articles/PMC6405612/ /pubmed/30561266 http://dx.doi.org/10.1161/JAHA.118.010364 Text en © 2018 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley. This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
spellingShingle Original Research
Fudim, Marat
Ambrosy, Andrew P.
Sun, Jie‐Lena
Anstrom, Kevin J.
Bart, Bradley A.
Butler, Javed
AbouEzzeddine, Omar
Greene, Stephen J.
Mentz, Robert J.
Redfield, Margaret M.
Reddy, Yogesh N.V.
Vaduganathan, Muthiah
Braunwald, Eugene
Hernandez, Adrian F.
Borlaug, Barry A.
Felker, G. Michael
High‐Sensitivity Troponin I in Hospitalized and Ambulatory Patients With Heart Failure With Preserved Ejection Fraction: Insights From the Heart Failure Clinical Research Network
title High‐Sensitivity Troponin I in Hospitalized and Ambulatory Patients With Heart Failure With Preserved Ejection Fraction: Insights From the Heart Failure Clinical Research Network
title_full High‐Sensitivity Troponin I in Hospitalized and Ambulatory Patients With Heart Failure With Preserved Ejection Fraction: Insights From the Heart Failure Clinical Research Network
title_fullStr High‐Sensitivity Troponin I in Hospitalized and Ambulatory Patients With Heart Failure With Preserved Ejection Fraction: Insights From the Heart Failure Clinical Research Network
title_full_unstemmed High‐Sensitivity Troponin I in Hospitalized and Ambulatory Patients With Heart Failure With Preserved Ejection Fraction: Insights From the Heart Failure Clinical Research Network
title_short High‐Sensitivity Troponin I in Hospitalized and Ambulatory Patients With Heart Failure With Preserved Ejection Fraction: Insights From the Heart Failure Clinical Research Network
title_sort high‐sensitivity troponin i in hospitalized and ambulatory patients with heart failure with preserved ejection fraction: insights from the heart failure clinical research network
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6405612/
https://www.ncbi.nlm.nih.gov/pubmed/30561266
http://dx.doi.org/10.1161/JAHA.118.010364
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