Persistently increased serum concentrations of cardiac troponin in patients with acutely decompensated heart failure are predictive of adverse outcomes.

BACKGROUND: Persistently increased serum concentrations of cardiac troponin (cTn) are a prognostic marker in patients suffering from chronic congestive heart failure (CHF), but the significance in acute cardiac decompensation is unclear. METHODS AND RESULTS: Serial blood samples were collected from 52 patients presenting with acute cardiac decompensation in the absence of an acute coronary event. Serial serum concentrations of cTnI, creatine kinase (CK)-MB, and brain natriuretic peptide (BNP) were measured by rapid assay. BNP and CK-MB steadily decreased from 902+/-529 pg/ml and 2.3+/-1.6 ng/ml at baseline to 453+/-427 pg/ml and 1.2+/-1.6 ng/ml on day 7, respectively, (p<0.0001 for both comparisons). In contrast, cTnI did not decrease significantly and, in 17 patients (35%), increased from 0.063+/-0.047 ng/ml at baseline to 0.167+/-0.181 ng/ml on day 1 (p<0.05). By single variable regression analysis, systolic blood pressure (SBP), use of inotropes or inodilators, vasodilators, and an initially elevated cTnI were predictors of elevated cTnI on day 1. By multiple variable analysis, an elevated SBP (as a mitigating factor) (odds ratios (OR) 0.12; 95% confidence intervals (CI): 0.02-0.76; p=0.0248), and high baseline cTnI (OR 13.85; 95%CI: 1.97-97.54; p=0.0083) were significant predictors of an elevated cTnI on day 1. Patients with elevated cTnI on day 1 had higher rates of worsening CHF and death from CHF than patients without such an increase (p<0.05). CONCLUSIONS: Persistently increased serum concentrations of cTn in patients with acutely decompensated heart failure are predictive of adverse outcomes.

[Infusion therapy at outpatient clinic in chronic end-stage heart failure].

OBJECTIVES: To determine whether drug infusions at ambulatory clinic in patients with end stage congestive heart failure are safe and reduce the period of hospitalization. METHODS: Between May 2000 and November 2006, 21 ambulatory patients with end stage congestive heart failure were treated with infusions of the natriuretic peptide, carperitide (6 patients, 43 infusions of mean 0.033 microg/kg/min for mean 3.7 hr), the phosphodiesterase inhibitor, olprinone (19 patients, 75 infusions of mean 0.11 microg/kg/min for mean 3.8 hr), or the catecholamines, dopamine or dobutamine(5 patients, 89 infusions of mean 3.3 microg/kg/min for mean 3.2 hr). RESULTS: Systolic and diastolic blood pressure was lower after infusion of carperitide, whereas catecholamines increased systolic blood pressure and heart rate (all differences from baseline p < 0.0001). Olprinone changed neither blood pressure nor heart rate. No adverse effect was observed, including arrhythmias or change in blood pressure requiring cessation of drug infusion. Mean urinary output per infusion was 979 ml for carperitide, 720ml for olprinone, and 594ml for catecholamines. There was no correlation between mean urinary output and dose of furosemide administered during intermittent infusion therapy. There was a close correlation between pre-infusion blood pressure and urinary output(systolic: p < 0.05; diastolic: p < 0.0001). Infusion therapy reduced the length of hospitalization (p < 0.05) in 7 patients from April 2005. CONCLUSIONS: Ambulatory, low-dose infusion therapy may not decrease the mortality of patients in end-stage congestive heart failure, but was safe and might represent an acceptable end-of-life therapeutic option.