Circulating Cardiac Troponin I Levels Measured by a Novel Highly Sensitive Assay in Acute Decompensated Heart Failure: Insights From the ASCEND-HF Trial

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.