R Zymliński1, M Sokolski2, P Siwolowski3, J Biegus2, S Nawrocka3, E A Jankowska2, J Todd4, R Yerramilli4, J Estis4, W Banasiak3, P Ponikowski2. 1. Centre for Heart Diseases - Clinical Military Hospital, Wroclaw, Poland. Electronic address: robertzymlinski@gmail.com. 2. Centre for Heart Diseases - Clinical Military Hospital, Wroclaw, Poland; Wroclaw Medical University, Department of Heart Diseases, Wroclaw, Poland. 3. Centre for Heart Diseases - Clinical Military Hospital, Wroclaw, Poland. 4. Singulex, California Inc., 1701 Harbor Bay Parkway, Alameda, CA 94502, United States.
Abstract
BACKGROUND: The interpretation and clinical usefulness of elevated levels of cardiac troponins in acute heart failure (AHF) remain controversial. We aimed to characterize the relationship between changes in cardiac troponin I (measured using a new high-sensitive immunoassay by single-molecule counting technology, Singulex, Alameda, USA; hs-TnI) during first 48h of hospital stay and patients' characteristics and the outcomes. METHODS AND RESULTS: We measured hs-TnI at baseline, after 24 and 48h in 130 AHF patients (mean age: 65±13years, 77% men). The percentage of patients with elevated hs-TnI (i.e., above the upper reference limit [URL]>10.19pg/mL) were: on admission - 59%, after 24h - 61%, and after 48h - 58%. Elevated baseline level of hs-TnI was associated with more severe dyspnoea on admission but neither peak level nor changes in hs-TnI during first 48h were related to the dyspnoea severity or magnitude of dyspnoea relief. During 1-year follow-up there were 32 (25%) cardiovascular deaths. Neither absolute baseline nor peak values of hs-TnI predicted cardiovascular mortality. Only changes in hs-TnI were independently associated with cardiovascular mortality with the strongest relationship seen in peak change in hs-TnI: patients with an increase vs. remaining patients - hazard ratio (95% confidence interval): 3.22 (1.52-6.82)p=0.002. CONCLUSIONS: Using the new assay (proved to be more sensitive that the other available troponin assays) we observed that approximately 60% of patients with AHF presented elevated hs-TnI above URL during first 48h of hospital stay. Only significant increase in hs-TnI predicted cardiovascular mortality.
BACKGROUND: The interpretation and clinical usefulness of elevated levels of cardiac troponins in acute heart failure (AHF) remain controversial. We aimed to characterize the relationship between changes in cardiac troponin I (measured using a new high-sensitive immunoassay by single-molecule counting technology, Singulex, Alameda, USA; hs-TnI) during first 48h of hospital stay and patients' characteristics and the outcomes. METHODS AND RESULTS: We measured hs-TnI at baseline, after 24 and 48h in 130 AHF patients (mean age: 65±13years, 77% men). The percentage of patients with elevated hs-TnI (i.e., above the upper reference limit [URL]>10.19pg/mL) were: on admission - 59%, after 24h - 61%, and after 48h - 58%. Elevated baseline level of hs-TnI was associated with more severe dyspnoea on admission but neither peak level nor changes in hs-TnI during first 48h were related to the dyspnoea severity or magnitude of dyspnoea relief. During 1-year follow-up there were 32 (25%) cardiovascular deaths. Neither absolute baseline nor peak values of hs-TnI predicted cardiovascular mortality. Only changes in hs-TnI were independently associated with cardiovascular mortality with the strongest relationship seen in peak change in hs-TnI: patients with an increase vs. remaining patients - hazard ratio (95% confidence interval): 3.22 (1.52-6.82)p=0.002. CONCLUSIONS: Using the new assay (proved to be more sensitive that the other available troponin assays) we observed that approximately 60% of patients with AHF presented elevated hs-TnI above URL during first 48h of hospital stay. Only significant increase in hs-TnI predicted cardiovascular mortality.
Authors: Barbara Ponikowska; Gracjan Iwanek; Agata Zdanowicz; Szymon Urban; Robert Zymliński; Piotr Ponikowski; Jan Biegus Journal: J Pers Med Date: 2022-05-16
Authors: Justyna Maria Sokolska; Mateusz Sokolski; Robert Zymliński; Jan Biegus; Paweł Siwołowski; Sylwia Nawrocka-Millward; Ewa Anita Jankowska; John Todd; Waldemar Banasiak; Piotr Ponikowski Journal: ESC Heart Fail Date: 2018-11-13
Authors: Jan Biegus; Biniyam Demissei; Douwe Postmus; Gad Cotter; Beth A Davison; G Michael Felker; Gerasimos Filippatos; Claudio Gimpelewicz; Barry Greenberg; Marco Metra; Thomas Severin; John R Teerlink; Adriaan A Voors; Piotr Ponikowski Journal: ESC Heart Fail Date: 2019-09-30
Authors: Justyna Maria Sokolska; Mateusz Sokolski; Robert Zymliński; Jan Biegus; Paweł Siwołowski; Sylwia Nawrocka-Millward; Katarzyna Swoboda; Piotr Gajewski; Ewa Anita Jankowska; Waldemar Banasiak; Piotr Ponikowski Journal: ESC Heart Fail Date: 2020-09-10
Authors: Szymon Urban; Mikołaj Błaziak; Maksym Jura; Gracjan Iwanek; Agata Zdanowicz; Mateusz Guzik; Artur Borkowski; Piotr Gajewski; Jan Biegus; Agnieszka Siennicka; Maciej Pondel; Petr Berka; Piotr Ponikowski; Robert Zymliński Journal: Biomedicines Date: 2022-06-27