Detection of high-sensitivity troponin in outpatients with stable pulmonary hypertension identifies a subgroup at higher risk of adverse outcomes.
BACKGROUND
The detection of elevations in cardiorenal biomarkers, such as troponins, B-type natriuretic peptides (BNPs), and neutrophil gelatinase-associated lipocalins, are associated with poor outcomes in patients hospitalized with acute heart failure. Less is known about the association of these markers with adverse events in chronic right ventricular dysfunction due to pulmonary hypertension, or whether their measurement may improve risk assessment in the outpatient setting.


METHODS AND RESULTS
We performed a cohort study of 108 patients attending the National Pulmonary Hypertension Unit in Dublin, Ireland, from 2007 to 2009. Cox proportional hazards analysis and receiver operating characteristic curves were used to determine predictors of mortality and hospitalization. Death or hospitalization occurred in 50 patients (46.3%) during the median study period of 4.1 years. Independent predictors of mortality were: 1) decreasing 6-minute walk test (6MWT; hazard ratio [HR] 12.8; P < .001); 2) BNP (HR 6.68; P < .001); and 3) highly sensitive troponin (hsTnT; HR 5.48; P < .001). Adjusted hazard analyses remained significant when hsTnT was added to a model with BNP and 6MWT (HR 9.26, 95% CI 3.61-23.79), as did the predictive ability of the model for death and rehospitalization (area under the receiver operating characteristic curve 0.81, 95% CI 0.73-0.90).


CONCLUSIONS
Detection of troponin using a highly sensitive assay identifies a pulmonary hypertension subgroup with a poorer prognosis. hsTnT may also be used in a risk prediction model to identify patients at higher risk who may require escalation of targeted pulmonary vasodilator therapies and closer clinical surveillance.
['Roy|Andrew K|AK|', 'McCullagh|Brian N|BN|', 'Segurado|Ricardo|R|', 'McGorrian|Catherine|C|', 'Keane|Elizabeth|E|', 'Keaney|John|J|', 'Fitzgibbon|Maria N|MN|', 'Mahon|Niall G|NG|', 'Murray|Patrick T|PT|', 'Gaine|Sean P|SP|']
D000209:Acute-Phase Proteins D000328:Adult D000368:Aged D015415:Biomarkers D002908:Chronic Disease D015331:Cohort Studies D005080:Exercise Test D005260:Female D006760:Hospitalization D006801:Humans D006976:Hypertension, Pulmonary D007494:Ireland D000071068:Lipocalin-2 D054834:Lipocalins D008297:Male D008875:Middle Aged D009026:Mortality D020097:Natriuretic Peptide, Brain D017063:Outcome Assessment, Health Care D010045:Outpatients D011237:Predictive Value of Tests D011379:Prognosis D016016:Proportional Hazards Models D011518:Proto-Oncogene Proteins D012372:ROC Curve D018570:Risk Assessment D020107:Troponin T D018497:Ventricular Dysfunction, Right
B-type natriuretic peptide prognosis Risk prediction models neutrophil gelatinase–associated lipocalin