Use of High-Sensitivity Troponin T to Identify Patients With Acute Heart Failure at Lower Risk for Adverse Outcomes. An Exploratory Analysis From the RELAX-AHF Trial

Peter Pang, John R. Teerlink, Adriaan A. Voors, Piotr Ponikowski, Barry H. Greenberg, Gerasimos Filippatos, G. Michael Felker, Beth A. Davison, Gad Cotter, Joshua Kriger, Margaret F. Prescott, Tsushung A. Hua, Thomas Severin, Marco Metra

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

Objectives: To determine if a baseline high-sensitivity troponin T (hsTnT) value ≤99th percentile upper reference limit (0.014 μg/l ["low hsTnT"]) identifies patients at low risk for adverse outcomes. Background: Approximately 85% of patients who present to emergency departments with acute heart failure are admitted. Identification of patients at low risk might decrease unnecessary admissions. Methods: A post hoc analysis was conducted from the RELAX-AHF (Serelaxin, Recombinant Human Relaxin-2, for Treatment of Acute Heart Failure) trial, which randomized patients within 16 h of presentation who had systolic blood pressure >125 mm Hg, mild to moderate renal impairment, and N-terminal pro-brain natriuretic peptide ≥1,600 ng/L to serelaxin versus placebo. Linear regression models for continuous endpoints and Cox models for time-to-event endpoints were used. Results: Of the 1,076 patients with available baseline hsTnT values, 107 (9.9%) had low hsTnT. No cardiovascular (CV) deaths through day 180 were observed in the low-hsTnT group compared with 79 CV deaths (7.3%) in patients with higher hsTnT. By univariate analyses, low hsTnT was associated with lower risk for all 5 primary outcomes: 1) days alive and out of the hospital by day 60; 2) CV death or rehospitalization for heart failure or renal failure by day 60; 3) length of stay; 4) worsening heart failure through day 5; and 5) CV death through day 180. After multivariate adjustment, only 180-day CV mortality remained significant (hazard ratio: 0.0; 95% confidence interval: 0.0 to 0.736; p = 0.0234; C-index = 0.838 [95% confidence interval: 0.798 to 0.878]). Conclusions: No CV deaths through day 180 were observed in patients with hsTnT levels ≤0.014 μg/l despite high N-terminal pro-brain natriuretic peptide levels. Low baseline hsTnT may identify patients with acute heart failure at very low risk for CV mortality.

Original languageEnglish (US)
JournalJACC: Heart Failure
DOIs
StateAccepted/In press - Nov 25 2015

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Relaxin
Troponin T
Heart Failure
Therapeutics
Brain Natriuretic Peptide
Linear Models
Confidence Intervals
Blood Pressure
Mortality
Proportional Hazards Models
Renal Insufficiency
Hospital Emergency Service
Length of Stay
Placebos
Kidney

Keywords

  • Acute heart failure
  • Emergency department
  • Risk stratification
  • Serelaxin

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Use of High-Sensitivity Troponin T to Identify Patients With Acute Heart Failure at Lower Risk for Adverse Outcomes. An Exploratory Analysis From the RELAX-AHF Trial. / Pang, Peter; Teerlink, John R.; Voors, Adriaan A.; Ponikowski, Piotr; Greenberg, Barry H.; Filippatos, Gerasimos; Felker, G. Michael; Davison, Beth A.; Cotter, Gad; Kriger, Joshua; Prescott, Margaret F.; Hua, Tsushung A.; Severin, Thomas; Metra, Marco.

In: JACC: Heart Failure, 25.11.2015.

Research output: Contribution to journalArticle

Pang, P, Teerlink, JR, Voors, AA, Ponikowski, P, Greenberg, BH, Filippatos, G, Felker, GM, Davison, BA, Cotter, G, Kriger, J, Prescott, MF, Hua, TA, Severin, T & Metra, M 2015, 'Use of High-Sensitivity Troponin T to Identify Patients With Acute Heart Failure at Lower Risk for Adverse Outcomes. An Exploratory Analysis From the RELAX-AHF Trial', JACC: Heart Failure. https://doi.org/10.1016/j.jchf.2016.02.009
Pang, Peter ; Teerlink, John R. ; Voors, Adriaan A. ; Ponikowski, Piotr ; Greenberg, Barry H. ; Filippatos, Gerasimos ; Felker, G. Michael ; Davison, Beth A. ; Cotter, Gad ; Kriger, Joshua ; Prescott, Margaret F. ; Hua, Tsushung A. ; Severin, Thomas ; Metra, Marco. / Use of High-Sensitivity Troponin T to Identify Patients With Acute Heart Failure at Lower Risk for Adverse Outcomes. An Exploratory Analysis From the RELAX-AHF Trial. In: JACC: Heart Failure. 2015.
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abstract = "Objectives: To determine if a baseline high-sensitivity troponin T (hsTnT) value ≤99th percentile upper reference limit (0.014 μg/l [{"}low hsTnT{"}]) identifies patients at low risk for adverse outcomes. Background: Approximately 85{\%} of patients who present to emergency departments with acute heart failure are admitted. Identification of patients at low risk might decrease unnecessary admissions. Methods: A post hoc analysis was conducted from the RELAX-AHF (Serelaxin, Recombinant Human Relaxin-2, for Treatment of Acute Heart Failure) trial, which randomized patients within 16 h of presentation who had systolic blood pressure >125 mm Hg, mild to moderate renal impairment, and N-terminal pro-brain natriuretic peptide ≥1,600 ng/L to serelaxin versus placebo. Linear regression models for continuous endpoints and Cox models for time-to-event endpoints were used. Results: Of the 1,076 patients with available baseline hsTnT values, 107 (9.9{\%}) had low hsTnT. No cardiovascular (CV) deaths through day 180 were observed in the low-hsTnT group compared with 79 CV deaths (7.3{\%}) in patients with higher hsTnT. By univariate analyses, low hsTnT was associated with lower risk for all 5 primary outcomes: 1) days alive and out of the hospital by day 60; 2) CV death or rehospitalization for heart failure or renal failure by day 60; 3) length of stay; 4) worsening heart failure through day 5; and 5) CV death through day 180. After multivariate adjustment, only 180-day CV mortality remained significant (hazard ratio: 0.0; 95{\%} confidence interval: 0.0 to 0.736; p = 0.0234; C-index = 0.838 [95{\%} confidence interval: 0.798 to 0.878]). Conclusions: No CV deaths through day 180 were observed in patients with hsTnT levels ≤0.014 μg/l despite high N-terminal pro-brain natriuretic peptide levels. Low baseline hsTnT may identify patients with acute heart failure at very low risk for CV mortality.",
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author = "Peter Pang and Teerlink, {John R.} and Voors, {Adriaan A.} and Piotr Ponikowski and Greenberg, {Barry H.} and Gerasimos Filippatos and Felker, {G. Michael} and Davison, {Beth A.} and Gad Cotter and Joshua Kriger and Prescott, {Margaret F.} and Hua, {Tsushung A.} and Thomas Severin and Marco Metra",
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AU - Pang, Peter

AU - Teerlink, John R.

AU - Voors, Adriaan A.

AU - Ponikowski, Piotr

AU - Greenberg, Barry H.

AU - Filippatos, Gerasimos

AU - Felker, G. Michael

AU - Davison, Beth A.

AU - Cotter, Gad

AU - Kriger, Joshua

AU - Prescott, Margaret F.

AU - Hua, Tsushung A.

AU - Severin, Thomas

AU - Metra, Marco

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N2 - Objectives: To determine if a baseline high-sensitivity troponin T (hsTnT) value ≤99th percentile upper reference limit (0.014 μg/l ["low hsTnT"]) identifies patients at low risk for adverse outcomes. Background: Approximately 85% of patients who present to emergency departments with acute heart failure are admitted. Identification of patients at low risk might decrease unnecessary admissions. Methods: A post hoc analysis was conducted from the RELAX-AHF (Serelaxin, Recombinant Human Relaxin-2, for Treatment of Acute Heart Failure) trial, which randomized patients within 16 h of presentation who had systolic blood pressure >125 mm Hg, mild to moderate renal impairment, and N-terminal pro-brain natriuretic peptide ≥1,600 ng/L to serelaxin versus placebo. Linear regression models for continuous endpoints and Cox models for time-to-event endpoints were used. Results: Of the 1,076 patients with available baseline hsTnT values, 107 (9.9%) had low hsTnT. No cardiovascular (CV) deaths through day 180 were observed in the low-hsTnT group compared with 79 CV deaths (7.3%) in patients with higher hsTnT. By univariate analyses, low hsTnT was associated with lower risk for all 5 primary outcomes: 1) days alive and out of the hospital by day 60; 2) CV death or rehospitalization for heart failure or renal failure by day 60; 3) length of stay; 4) worsening heart failure through day 5; and 5) CV death through day 180. After multivariate adjustment, only 180-day CV mortality remained significant (hazard ratio: 0.0; 95% confidence interval: 0.0 to 0.736; p = 0.0234; C-index = 0.838 [95% confidence interval: 0.798 to 0.878]). Conclusions: No CV deaths through day 180 were observed in patients with hsTnT levels ≤0.014 μg/l despite high N-terminal pro-brain natriuretic peptide levels. Low baseline hsTnT may identify patients with acute heart failure at very low risk for CV mortality.

AB - Objectives: To determine if a baseline high-sensitivity troponin T (hsTnT) value ≤99th percentile upper reference limit (0.014 μg/l ["low hsTnT"]) identifies patients at low risk for adverse outcomes. Background: Approximately 85% of patients who present to emergency departments with acute heart failure are admitted. Identification of patients at low risk might decrease unnecessary admissions. Methods: A post hoc analysis was conducted from the RELAX-AHF (Serelaxin, Recombinant Human Relaxin-2, for Treatment of Acute Heart Failure) trial, which randomized patients within 16 h of presentation who had systolic blood pressure >125 mm Hg, mild to moderate renal impairment, and N-terminal pro-brain natriuretic peptide ≥1,600 ng/L to serelaxin versus placebo. Linear regression models for continuous endpoints and Cox models for time-to-event endpoints were used. Results: Of the 1,076 patients with available baseline hsTnT values, 107 (9.9%) had low hsTnT. No cardiovascular (CV) deaths through day 180 were observed in the low-hsTnT group compared with 79 CV deaths (7.3%) in patients with higher hsTnT. By univariate analyses, low hsTnT was associated with lower risk for all 5 primary outcomes: 1) days alive and out of the hospital by day 60; 2) CV death or rehospitalization for heart failure or renal failure by day 60; 3) length of stay; 4) worsening heart failure through day 5; and 5) CV death through day 180. After multivariate adjustment, only 180-day CV mortality remained significant (hazard ratio: 0.0; 95% confidence interval: 0.0 to 0.736; p = 0.0234; C-index = 0.838 [95% confidence interval: 0.798 to 0.878]). Conclusions: No CV deaths through day 180 were observed in patients with hsTnT levels ≤0.014 μg/l despite high N-terminal pro-brain natriuretic peptide levels. Low baseline hsTnT may identify patients with acute heart failure at very low risk for CV mortality.

KW - Acute heart failure

KW - Emergency department

KW - Risk stratification

KW - Serelaxin

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