Serial high sensitivity cardiac troponin T measurement in acute heart failure: Insights from the RELAX-AHF study

G. Michael Felker, Robert J. Mentz, John R. Teerlink, Adriaan A. Voors, Peter Pang, Piotr Ponikowski, Barry H. Greenberg, Gerasimos Filippatos, Beth A. Davison, Gad Cotter, Margaret F. Prescott, Tsushung A. Hua, Sara Lopez-Pintado, Thomas Severin, Marco Metra

Research output: Contribution to journalArticle

54 Citations (Scopus)

Abstract

Aims Troponin elevation is common in acute heart failure (AHF) and may be useful for prognostication; however, available data are mixed and many previous studies used older, less sensitive assays. We examined the association between serial measurements of high-sensitivity cardiac troponin T (hs-cTnT) and outcomes in RELAX-AHF. Methods and results Hs-cTnT was measured at baseline and days 2, 5, and 14. We assessed the relationship between baseline, peak and peak change hs-cTnT with dyspnoea relief by visual analogue scale, cardiovascular death, or HF/renal hospitalization to 60 days and cardiovascular mortality to 180 days. Models were adjusted for clinical variables and treatment assignment. Whether baseline troponin status affected the treatment effect of serelaxin was assessed using interactions terms. In 1074 patients, the median baseline troponin was 0.033 μg/L, and 90% of patients were above the 99th upper reference limit (URL). Patients with hs-cTnT >median were more likely to be men with ischaemic heart disease, worse renal function, and higher N-terminal pro-brain natriuretic peptide. Higher baseline or peak hs-cTnT and greater peak change were associated with worse outcomes independent of adjustment for covariates, but relationships were generally strongest for 180-day cardiovascular mortality (hazard ratio per doubling of baseline hs-cTnT = 1.36, 95% confidence interval 1.15-1.60). Troponin was most strongly associated with death from heart failure or from other cardiovascular causes. The treatment effect of serelaxin did not differ by baseline troponin levels. Conclusion Hs-cTnT was elevated above the 99% URL in the majority of AHF patients. Baseline, peak, and peak change hs-cTnT were associated with worse outcomes, with the strongest relationship with 180-day cardiovascular mortality.

Original languageEnglish (US)
Pages (from-to)1262-1270
Number of pages9
JournalEuropean Journal of Heart Failure
Volume17
Issue number12
DOIs
StatePublished - Dec 1 2015

Fingerprint

Troponin T
Troponin
Heart Failure
Mortality
Kidney
Brain Natriuretic Peptide
Visual Analog Scale
Dyspnea
Myocardial Ischemia
Hospitalization
Therapeutics
Confidence Intervals

Keywords

  • Acute heart failure
  • Dyspnoea
  • High-sensitivity cardiac troponin T
  • mortality
  • Outcomes

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Serial high sensitivity cardiac troponin T measurement in acute heart failure : Insights from the RELAX-AHF study. / Felker, G. Michael; Mentz, Robert J.; Teerlink, John R.; Voors, Adriaan A.; Pang, Peter; Ponikowski, Piotr; Greenberg, Barry H.; Filippatos, Gerasimos; Davison, Beth A.; Cotter, Gad; Prescott, Margaret F.; Hua, Tsushung A.; Lopez-Pintado, Sara; Severin, Thomas; Metra, Marco.

In: European Journal of Heart Failure, Vol. 17, No. 12, 01.12.2015, p. 1262-1270.

Research output: Contribution to journalArticle

Felker, GM, Mentz, RJ, Teerlink, JR, Voors, AA, Pang, P, Ponikowski, P, Greenberg, BH, Filippatos, G, Davison, BA, Cotter, G, Prescott, MF, Hua, TA, Lopez-Pintado, S, Severin, T & Metra, M 2015, 'Serial high sensitivity cardiac troponin T measurement in acute heart failure: Insights from the RELAX-AHF study', European Journal of Heart Failure, vol. 17, no. 12, pp. 1262-1270. https://doi.org/10.1002/ejhf.341
Felker, G. Michael ; Mentz, Robert J. ; Teerlink, John R. ; Voors, Adriaan A. ; Pang, Peter ; Ponikowski, Piotr ; Greenberg, Barry H. ; Filippatos, Gerasimos ; Davison, Beth A. ; Cotter, Gad ; Prescott, Margaret F. ; Hua, Tsushung A. ; Lopez-Pintado, Sara ; Severin, Thomas ; Metra, Marco. / Serial high sensitivity cardiac troponin T measurement in acute heart failure : Insights from the RELAX-AHF study. In: European Journal of Heart Failure. 2015 ; Vol. 17, No. 12. pp. 1262-1270.
@article{4ae232e0622341af9f04dd47a4e1498e,
title = "Serial high sensitivity cardiac troponin T measurement in acute heart failure: Insights from the RELAX-AHF study",
abstract = "Aims Troponin elevation is common in acute heart failure (AHF) and may be useful for prognostication; however, available data are mixed and many previous studies used older, less sensitive assays. We examined the association between serial measurements of high-sensitivity cardiac troponin T (hs-cTnT) and outcomes in RELAX-AHF. Methods and results Hs-cTnT was measured at baseline and days 2, 5, and 14. We assessed the relationship between baseline, peak and peak change hs-cTnT with dyspnoea relief by visual analogue scale, cardiovascular death, or HF/renal hospitalization to 60 days and cardiovascular mortality to 180 days. Models were adjusted for clinical variables and treatment assignment. Whether baseline troponin status affected the treatment effect of serelaxin was assessed using interactions terms. In 1074 patients, the median baseline troponin was 0.033 μg/L, and 90{\%} of patients were above the 99th upper reference limit (URL). Patients with hs-cTnT >median were more likely to be men with ischaemic heart disease, worse renal function, and higher N-terminal pro-brain natriuretic peptide. Higher baseline or peak hs-cTnT and greater peak change were associated with worse outcomes independent of adjustment for covariates, but relationships were generally strongest for 180-day cardiovascular mortality (hazard ratio per doubling of baseline hs-cTnT = 1.36, 95{\%} confidence interval 1.15-1.60). Troponin was most strongly associated with death from heart failure or from other cardiovascular causes. The treatment effect of serelaxin did not differ by baseline troponin levels. Conclusion Hs-cTnT was elevated above the 99{\%} URL in the majority of AHF patients. Baseline, peak, and peak change hs-cTnT were associated with worse outcomes, with the strongest relationship with 180-day cardiovascular mortality.",
keywords = "Acute heart failure, Dyspnoea, High-sensitivity cardiac troponin T, mortality, Outcomes",
author = "Felker, {G. Michael} and Mentz, {Robert J.} and Teerlink, {John R.} and Voors, {Adriaan A.} and Peter Pang and Piotr Ponikowski and Greenberg, {Barry H.} and Gerasimos Filippatos and Davison, {Beth A.} and Gad Cotter and Prescott, {Margaret F.} and Hua, {Tsushung A.} and Sara Lopez-Pintado and Thomas Severin and Marco Metra",
year = "2015",
month = "12",
day = "1",
doi = "10.1002/ejhf.341",
language = "English (US)",
volume = "17",
pages = "1262--1270",
journal = "European Journal of Heart Failure",
issn = "1388-9842",
publisher = "Oxford University Press",
number = "12",

}

TY - JOUR

T1 - Serial high sensitivity cardiac troponin T measurement in acute heart failure

T2 - Insights from the RELAX-AHF study

AU - Felker, G. Michael

AU - Mentz, Robert J.

AU - Teerlink, John R.

AU - Voors, Adriaan A.

AU - Pang, Peter

AU - Ponikowski, Piotr

AU - Greenberg, Barry H.

AU - Filippatos, Gerasimos

AU - Davison, Beth A.

AU - Cotter, Gad

AU - Prescott, Margaret F.

AU - Hua, Tsushung A.

AU - Lopez-Pintado, Sara

AU - Severin, Thomas

AU - Metra, Marco

PY - 2015/12/1

Y1 - 2015/12/1

N2 - Aims Troponin elevation is common in acute heart failure (AHF) and may be useful for prognostication; however, available data are mixed and many previous studies used older, less sensitive assays. We examined the association between serial measurements of high-sensitivity cardiac troponin T (hs-cTnT) and outcomes in RELAX-AHF. Methods and results Hs-cTnT was measured at baseline and days 2, 5, and 14. We assessed the relationship between baseline, peak and peak change hs-cTnT with dyspnoea relief by visual analogue scale, cardiovascular death, or HF/renal hospitalization to 60 days and cardiovascular mortality to 180 days. Models were adjusted for clinical variables and treatment assignment. Whether baseline troponin status affected the treatment effect of serelaxin was assessed using interactions terms. In 1074 patients, the median baseline troponin was 0.033 μg/L, and 90% of patients were above the 99th upper reference limit (URL). Patients with hs-cTnT >median were more likely to be men with ischaemic heart disease, worse renal function, and higher N-terminal pro-brain natriuretic peptide. Higher baseline or peak hs-cTnT and greater peak change were associated with worse outcomes independent of adjustment for covariates, but relationships were generally strongest for 180-day cardiovascular mortality (hazard ratio per doubling of baseline hs-cTnT = 1.36, 95% confidence interval 1.15-1.60). Troponin was most strongly associated with death from heart failure or from other cardiovascular causes. The treatment effect of serelaxin did not differ by baseline troponin levels. Conclusion Hs-cTnT was elevated above the 99% URL in the majority of AHF patients. Baseline, peak, and peak change hs-cTnT were associated with worse outcomes, with the strongest relationship with 180-day cardiovascular mortality.

AB - Aims Troponin elevation is common in acute heart failure (AHF) and may be useful for prognostication; however, available data are mixed and many previous studies used older, less sensitive assays. We examined the association between serial measurements of high-sensitivity cardiac troponin T (hs-cTnT) and outcomes in RELAX-AHF. Methods and results Hs-cTnT was measured at baseline and days 2, 5, and 14. We assessed the relationship between baseline, peak and peak change hs-cTnT with dyspnoea relief by visual analogue scale, cardiovascular death, or HF/renal hospitalization to 60 days and cardiovascular mortality to 180 days. Models were adjusted for clinical variables and treatment assignment. Whether baseline troponin status affected the treatment effect of serelaxin was assessed using interactions terms. In 1074 patients, the median baseline troponin was 0.033 μg/L, and 90% of patients were above the 99th upper reference limit (URL). Patients with hs-cTnT >median were more likely to be men with ischaemic heart disease, worse renal function, and higher N-terminal pro-brain natriuretic peptide. Higher baseline or peak hs-cTnT and greater peak change were associated with worse outcomes independent of adjustment for covariates, but relationships were generally strongest for 180-day cardiovascular mortality (hazard ratio per doubling of baseline hs-cTnT = 1.36, 95% confidence interval 1.15-1.60). Troponin was most strongly associated with death from heart failure or from other cardiovascular causes. The treatment effect of serelaxin did not differ by baseline troponin levels. Conclusion Hs-cTnT was elevated above the 99% URL in the majority of AHF patients. Baseline, peak, and peak change hs-cTnT were associated with worse outcomes, with the strongest relationship with 180-day cardiovascular mortality.

KW - Acute heart failure

KW - Dyspnoea

KW - High-sensitivity cardiac troponin T

KW - mortality

KW - Outcomes

UR - http://www.scopus.com/inward/record.url?scp=84949537528&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84949537528&partnerID=8YFLogxK

U2 - 10.1002/ejhf.341

DO - 10.1002/ejhf.341

M3 - Article

C2 - 26333655

AN - SCOPUS:84949537528

VL - 17

SP - 1262

EP - 1270

JO - European Journal of Heart Failure

JF - European Journal of Heart Failure

SN - 1388-9842

IS - 12

ER -