BACKGROUND:Circulating cardiac troponin levels (cTn), representative of myocardial injury, are commonly elevated in heart failure (HF) and related to adverse clinical events. However, whether cTn represents a spectrum of risk in HF is unclear. METHODS:Baseline, 48-72-hour, and 30-day plasma cTnI was measured with the use of a new highly sensitive assay in 900 subjects with acute decompensated HF (ADHF) in ASCEND-HF. Multivariable models determined the relationship between cTnI and outcomes. RESULTS:The median (interquartile range) cTnI was 16.4 (9.3-31.6) ng/L at baseline, 14.1 (7.8-29.7) ng/L at 48-72 hours, and 11.6 (6.8-22.5) ng/L at 30 days. After additional adjustment for N-terminal pro-B-type natriuretic peptide (NT-proBNP) to established risk predictors, both baseline (odds ratio [OR] 1.25; P = .03) and 48-72-hour (OR 1.43; P = .001) cTnI were associated with higher risk for death or worsening HF before discharge. However, only cTnI at 30 days was associated with 180-day death (hazard ratio 1.25; P = .007). There were no curvilinear associations between changing cTnI and clinical outcomes. CONCLUSIONS:Circulating cTnI level was associated with clinical outcomes in ADHF, but these observations diminished with additional adjustment for NT-proBNP. Although they likely represent a spectrum of risk in ADHF, these findings question the implications of changing cTnI levels during treatment.

译文

背景:代表心肌损伤的循环心肌肌钙蛋白水平(cTn)通常在心力衰竭(HF)中升高,并与不良临床事件相关。但是,尚不清楚cTn是否代表HF的风险范围。
方法:采用新的高灵敏测定法,对900例急性失代偿性HF(ADHF)的ASCEND-HF患者进行基线,48-72小时和30天血浆cTnI的测量。多变量模型确定了cTnI与结果之间的关系。
结果:基线时的cTnI中位数(四分位数范围)为16.4(9.3-31.6)ng / L,在48-72小时时为14.1(7.8-29.7)ng / L,在30天时为11.6(6.8-22.5)ng / L 。在对N末端前B型利钠尿肽(NT-proBNP)进行额外调整以建立既定的风险预测指标后,基线(赔率[OR] 1.25; P = .03)和48-72小时(OR 1.43; P) = .001)cTnI与出院前死亡或HF恶化的较高风险相关。但是,只有30天的cTnI与180天的死亡相关(危险比1.25; P = .007)。 cTnI改变与临床结果之间没有曲线相关性。
结论:循环中的cTnI水平与ADHF的临床结局相关,但这些观察结果随着NT-proBNP的进一步调整而减弱。尽管它们可能代表了ADHF的一系列风险,但这些发现对治疗期间改变cTnI水平的含义提出了质疑。

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