Profiles of Serial Changes in Cardiac Troponin T Concentrations and Outcome in Ambulatory Patients With Chronic Heart Failure
Objectives The purpose of this study was to determine whether different profiles of cardiac troponin T (cTnT) values assessed over time would yield incremental prognostic information on clinically stable outpatients with heart failure (HF). Background cTnT levels were used to estimate prognosis in H...
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| Veröffentlicht in: | Journal of the American College of Cardiology 2009-10, Vol.54 (18), p.1715-1721 |
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| creator | Miller, Wayne L., MD, PhD Hartman, Karen A., BSN Burritt, Mary F., PhD Grill, Diane E., MSc Jaffe, Allan S., MD |
| description | Objectives The purpose of this study was to determine whether different profiles of cardiac troponin T (cTnT) values assessed over time would yield incremental prognostic information on clinically stable outpatients with heart failure (HF). Background cTnT levels were used to estimate prognosis in HF; however, most studies evaluated hospitalized patients using single measurements. Methods A cohort of 172 New York Heart Association functional class III to IV outpatients was prospectively studied with serial cTnT measurements collected every 3 months over a 2-year period. The primary end point was death or cardiac transplantation, and secondary end points included HF hospitalization. Results Of the 172 patients, 22 (13%) died or underwent transplantation during the first year. Therefore, 150 patients were included in the second-year analysis of 3 pre-determined groups: 1) no serial cTnT elevations (defined as |
| doi_str_mv | 10.1016/j.jacc.2009.07.025 |
| format | Article |
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Background cTnT levels were used to estimate prognosis in HF; however, most studies evaluated hospitalized patients using single measurements. Methods A cohort of 172 New York Heart Association functional class III to IV outpatients was prospectively studied with serial cTnT measurements collected every 3 months over a 2-year period. The primary end point was death or cardiac transplantation, and secondary end points included HF hospitalization. Results Of the 172 patients, 22 (13%) died or underwent transplantation during the first year. Therefore, 150 patients were included in the second-year analysis of 3 pre-determined groups: 1) no serial cTnT elevations (defined as <0.01 ng/ml); 2) 1 or more, but not all cTnT values elevated ≥0.01 ng/ml; and 3) all cTnT values elevated during the first year. During the second year, 30 events occurred: 53 patients had persistently normal cTnT levels (<0.01 ng/ml) with 6 primary events (11%); 57 patients had 1 or more but not all cTnT levels elevated with 11 events (19%); 40 patients demonstrated persistently elevated cTnT levels with 13 (33%) primary events (odds ratio: 3.77; 95% confidence interval: 1.28 to 11.07, p = 0.02). Conclusions Elevations in cTnT, even using a low threshold of 0.01 ng/ml, detected during routine clinical follow-up of ambulatory patients with HF, are highly associated with an increased risk of events, particularly with frequent or persistent cTnT elevations of ≥0.01 ng/ml. Therefore, the ability to monitor clinical change through serial cTnT measurements may add to risk assessment in the ambulatory HF population.</description><identifier>ISSN: 0735-1097</identifier><identifier>EISSN: 1558-3597</identifier><identifier>DOI: 10.1016/j.jacc.2009.07.025</identifier><identifier>PMID: 19850213</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Aged ; Cardiology ; Cardiovascular ; chronic heart failure ; Chronic obstructive pulmonary disease ; Confidence intervals ; Drug therapy ; Echocardiography ; Female ; Follow-Up Studies ; Heart attacks ; Heart failure ; Heart Failure - blood ; Heart Failure - diagnostic imaging ; Heart Failure - physiopathology ; Hospitalization ; Humans ; Hypertension ; Internal Medicine ; Male ; Medical prognosis ; Office Visits - trends ; outcomes ; Outpatients ; Prognosis ; Prospective Studies ; Software ; Stroke Volume - physiology ; Studies ; troponin T ; Troponin T - blood ; Ventricular Function, Left - physiology</subject><ispartof>Journal of the American College of Cardiology, 2009-10, Vol.54 (18), p.1715-1721</ispartof><rights>American College of Cardiology Foundation</rights><rights>2009 American College of Cardiology Foundation</rights><rights>Copyright Elsevier Limited Oct 27, 2009</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c548t-41498f15ddf4a66703f5eb31b8f3837efcc8d0bac8a44f9fc8ac9bfd489fd6c3</citedby><cites>FETCH-LOGICAL-c548t-41498f15ddf4a66703f5eb31b8f3837efcc8d0bac8a44f9fc8ac9bfd489fd6c3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.jacc.2009.07.025$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,780,784,3548,27923,27924,45994</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/19850213$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Miller, Wayne L., MD, PhD</creatorcontrib><creatorcontrib>Hartman, Karen A., BSN</creatorcontrib><creatorcontrib>Burritt, Mary F., PhD</creatorcontrib><creatorcontrib>Grill, Diane E., MSc</creatorcontrib><creatorcontrib>Jaffe, Allan S., MD</creatorcontrib><title>Profiles of Serial Changes in Cardiac Troponin T Concentrations and Outcome in Ambulatory Patients With Chronic Heart Failure</title><title>Journal of the American College of Cardiology</title><addtitle>J Am Coll Cardiol</addtitle><description>Objectives The purpose of this study was to determine whether different profiles of cardiac troponin T (cTnT) values assessed over time would yield incremental prognostic information on clinically stable outpatients with heart failure (HF). Background cTnT levels were used to estimate prognosis in HF; however, most studies evaluated hospitalized patients using single measurements. Methods A cohort of 172 New York Heart Association functional class III to IV outpatients was prospectively studied with serial cTnT measurements collected every 3 months over a 2-year period. The primary end point was death or cardiac transplantation, and secondary end points included HF hospitalization. Results Of the 172 patients, 22 (13%) died or underwent transplantation during the first year. Therefore, 150 patients were included in the second-year analysis of 3 pre-determined groups: 1) no serial cTnT elevations (defined as <0.01 ng/ml); 2) 1 or more, but not all cTnT values elevated ≥0.01 ng/ml; and 3) all cTnT values elevated during the first year. During the second year, 30 events occurred: 53 patients had persistently normal cTnT levels (<0.01 ng/ml) with 6 primary events (11%); 57 patients had 1 or more but not all cTnT levels elevated with 11 events (19%); 40 patients demonstrated persistently elevated cTnT levels with 13 (33%) primary events (odds ratio: 3.77; 95% confidence interval: 1.28 to 11.07, p = 0.02). Conclusions Elevations in cTnT, even using a low threshold of 0.01 ng/ml, detected during routine clinical follow-up of ambulatory patients with HF, are highly associated with an increased risk of events, particularly with frequent or persistent cTnT elevations of ≥0.01 ng/ml. Therefore, the ability to monitor clinical change through serial cTnT measurements may add to risk assessment in the ambulatory HF population.</description><subject>Aged</subject><subject>Cardiology</subject><subject>Cardiovascular</subject><subject>chronic heart failure</subject><subject>Chronic obstructive pulmonary disease</subject><subject>Confidence intervals</subject><subject>Drug therapy</subject><subject>Echocardiography</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Heart attacks</subject><subject>Heart failure</subject><subject>Heart Failure - blood</subject><subject>Heart Failure - diagnostic imaging</subject><subject>Heart Failure - physiopathology</subject><subject>Hospitalization</subject><subject>Humans</subject><subject>Hypertension</subject><subject>Internal Medicine</subject><subject>Male</subject><subject>Medical prognosis</subject><subject>Office Visits - trends</subject><subject>outcomes</subject><subject>Outpatients</subject><subject>Prognosis</subject><subject>Prospective Studies</subject><subject>Software</subject><subject>Stroke Volume - physiology</subject><subject>Studies</subject><subject>troponin T</subject><subject>Troponin T - blood</subject><subject>Ventricular Function, Left - physiology</subject><issn>0735-1097</issn><issn>1558-3597</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2009</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkkFr3DAQhUVpaTZp_0APRVDoze7IsmQJSiGYpikEEshCj0KWpUau19pKdmEP_e-R2YVADu1pYPjeg3lvEHpHoCRA-KehHLQxZQUgS2hKqNgLtCGMiYIy2bxEG2goKwjI5gydpzQAABdEvkZnRAoGFaEb9PcuBudHm3Bw-N5Gr0fcPujpZ974Cbc69l4bvI1hH6a82OI2TMZOc9SzD1PCeurx7TKbsLOr4HLXLaOeQzzgu0xkMOEffn7IpjEbGHxtdZzxlfbjEu0b9MrpMdm3p3mBtldft-11cXP77Xt7eVMYVou5qEkthSOs712tOW-AOmY7SjrhqKCNdcaIHjpthK5rJ12eRnaur4V0PTf0An082u5j-L3YNKudT8aOo55sWJLinFNGSPNfsMpQwyjP4Idn4BCWOOUbFGHAK1bn6DNVHSkTQ0rROrWPfqfjQRFQa4VqUGuFaq1QQaNyhVn0_mS9dDvbP0lOnWXg8xGwObE_3kaVTA7a2N5Ha2bVB_9v_y_P5Gb0uRk9_rIHm57uUKlSoO7XJ1p_CCRUvAagj5ycwqs</recordid><startdate>20091027</startdate><enddate>20091027</enddate><creator>Miller, Wayne L., MD, PhD</creator><creator>Hartman, Karen A., BSN</creator><creator>Burritt, Mary F., PhD</creator><creator>Grill, Diane E., MSc</creator><creator>Jaffe, Allan S., MD</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><scope>6I.</scope><scope>AAFTH</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>7TK</scope><scope>H94</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7U7</scope><scope>C1K</scope><scope>7X8</scope></search><sort><creationdate>20091027</creationdate><title>Profiles of Serial Changes in Cardiac Troponin T Concentrations and Outcome in Ambulatory Patients With Chronic Heart Failure</title><author>Miller, Wayne L., MD, PhD ; Hartman, Karen A., BSN ; Burritt, Mary F., PhD ; Grill, Diane E., MSc ; Jaffe, Allan S., MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c548t-41498f15ddf4a66703f5eb31b8f3837efcc8d0bac8a44f9fc8ac9bfd489fd6c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2009</creationdate><topic>Aged</topic><topic>Cardiology</topic><topic>Cardiovascular</topic><topic>chronic heart failure</topic><topic>Chronic obstructive pulmonary disease</topic><topic>Confidence intervals</topic><topic>Drug therapy</topic><topic>Echocardiography</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Heart attacks</topic><topic>Heart failure</topic><topic>Heart Failure - blood</topic><topic>Heart Failure - diagnostic imaging</topic><topic>Heart Failure - physiopathology</topic><topic>Hospitalization</topic><topic>Humans</topic><topic>Hypertension</topic><topic>Internal Medicine</topic><topic>Male</topic><topic>Medical prognosis</topic><topic>Office Visits - trends</topic><topic>outcomes</topic><topic>Outpatients</topic><topic>Prognosis</topic><topic>Prospective Studies</topic><topic>Software</topic><topic>Stroke Volume - physiology</topic><topic>Studies</topic><topic>troponin T</topic><topic>Troponin T - blood</topic><topic>Ventricular Function, Left - physiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Miller, Wayne L., MD, PhD</creatorcontrib><creatorcontrib>Hartman, Karen A., BSN</creatorcontrib><creatorcontrib>Burritt, Mary F., PhD</creatorcontrib><creatorcontrib>Grill, Diane E., MSc</creatorcontrib><creatorcontrib>Jaffe, Allan S., MD</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>Toxicology Abstracts</collection><collection>Environmental Sciences and Pollution Management</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of the American College of Cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Miller, Wayne L., MD, PhD</au><au>Hartman, Karen A., BSN</au><au>Burritt, Mary F., PhD</au><au>Grill, Diane E., MSc</au><au>Jaffe, Allan S., MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Profiles of Serial Changes in Cardiac Troponin T Concentrations and Outcome in Ambulatory Patients With Chronic Heart Failure</atitle><jtitle>Journal of the American College of Cardiology</jtitle><addtitle>J Am Coll Cardiol</addtitle><date>2009-10-27</date><risdate>2009</risdate><volume>54</volume><issue>18</issue><spage>1715</spage><epage>1721</epage><pages>1715-1721</pages><issn>0735-1097</issn><eissn>1558-3597</eissn><abstract>Objectives The purpose of this study was to determine whether different profiles of cardiac troponin T (cTnT) values assessed over time would yield incremental prognostic information on clinically stable outpatients with heart failure (HF). Background cTnT levels were used to estimate prognosis in HF; however, most studies evaluated hospitalized patients using single measurements. Methods A cohort of 172 New York Heart Association functional class III to IV outpatients was prospectively studied with serial cTnT measurements collected every 3 months over a 2-year period. The primary end point was death or cardiac transplantation, and secondary end points included HF hospitalization. Results Of the 172 patients, 22 (13%) died or underwent transplantation during the first year. Therefore, 150 patients were included in the second-year analysis of 3 pre-determined groups: 1) no serial cTnT elevations (defined as <0.01 ng/ml); 2) 1 or more, but not all cTnT values elevated ≥0.01 ng/ml; and 3) all cTnT values elevated during the first year. During the second year, 30 events occurred: 53 patients had persistently normal cTnT levels (<0.01 ng/ml) with 6 primary events (11%); 57 patients had 1 or more but not all cTnT levels elevated with 11 events (19%); 40 patients demonstrated persistently elevated cTnT levels with 13 (33%) primary events (odds ratio: 3.77; 95% confidence interval: 1.28 to 11.07, p = 0.02). Conclusions Elevations in cTnT, even using a low threshold of 0.01 ng/ml, detected during routine clinical follow-up of ambulatory patients with HF, are highly associated with an increased risk of events, particularly with frequent or persistent cTnT elevations of ≥0.01 ng/ml. Therefore, the ability to monitor clinical change through serial cTnT measurements may add to risk assessment in the ambulatory HF population.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>19850213</pmid><doi>10.1016/j.jacc.2009.07.025</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Aged Cardiology Cardiovascular chronic heart failure Chronic obstructive pulmonary disease Confidence intervals Drug therapy Echocardiography Female Follow-Up Studies Heart attacks Heart failure Heart Failure - blood Heart Failure - diagnostic imaging Heart Failure - physiopathology Hospitalization Humans Hypertension Internal Medicine Male Medical prognosis Office Visits - trends outcomes Outpatients Prognosis Prospective Studies Software Stroke Volume - physiology Studies troponin T Troponin T - blood Ventricular Function, Left - physiology |
| title | Profiles of Serial Changes in Cardiac Troponin T Concentrations and Outcome in Ambulatory Patients With Chronic Heart Failure |
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