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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.

Publication ,  Journal Article
Pang, PS; Teerlink, JR; Voors, AA; Ponikowski, P; Greenberg, BH; Filippatos, G; Felker, GM; Davison, BA; Cotter, G; Kriger, J; Prescott, MF ...
Published in: JACC Heart Fail
July 2016

OBJECTIVES: The aim of this study was 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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Published In

JACC Heart Fail

DOI

EISSN

2213-1787

Publication Date

July 2016

Volume

4

Issue

7

Start / End Page

591 / 599

Location

United States

Related Subject Headings

  • Troponin T
  • Treatment Outcome
  • Risk Assessment
  • Renal Insufficiency
  • Relaxin
  • Recombinant Proteins
  • Randomized Controlled Trials as Topic
  • Proportional Hazards Models
  • Prognosis
  • Peptide Fragments
 

Citation

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Pang, P. S., Teerlink, J. R., Voors, A. A., Ponikowski, P., Greenberg, B. H., Filippatos, G., … Metra, M. (2016). 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 Fail, 4(7), 591–599. https://doi.org/10.1016/j.jchf.2016.02.009
Pang, Peter S., John R. Teerlink, Adriaan A. Voors, Piotr Ponikowski, Barry H. Greenberg, Gerasimos Filippatos, G Michael Felker, et al. “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 Fail 4, no. 7 (July 2016): 591–99. https://doi.org/10.1016/j.jchf.2016.02.009.
Pang PS, Teerlink JR, Voors AA, Ponikowski P, Greenberg BH, Filippatos G, et al. 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 Fail. 2016 Jul;4(7):591–9.
Pang, Peter S., et al. “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 Fail, vol. 4, no. 7, July 2016, pp. 591–99. Pubmed, doi:10.1016/j.jchf.2016.02.009.
Pang PS, 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. 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 Fail. 2016 Jul;4(7):591–599.
Journal cover image

Published In

JACC Heart Fail

DOI

EISSN

2213-1787

Publication Date

July 2016

Volume

4

Issue

7

Start / End Page

591 / 599

Location

United States

Related Subject Headings

  • Troponin T
  • Treatment Outcome
  • Risk Assessment
  • Renal Insufficiency
  • Relaxin
  • Recombinant Proteins
  • Randomized Controlled Trials as Topic
  • Proportional Hazards Models
  • Prognosis
  • Peptide Fragments