| Objective To discussion the correlationship of change and level and prognosis,basis etiology of cardiac troponin I(cTnI),Brain natriuretic peptide(BNP) in patients with acute heart failure(AHF).Methods Serial blood samples were collected from 120 patients presenting with AHF,who were divided according to etiology into four groups: Ischemia heart diseases (IHD,n=41),Valvular heart diseases(VHD,n=28),Dilated cardiomyopathy (DCM,n=30),Hypertensive heart diseases(HHD,n=21). Serial venous blood concentrations of cTnI,BNP were measured immediately on admission and at the time of symptom remission. According to the cTnI concentration on admission, all patients were divided into two groups: cTnI(+) group(n=24 ) and cTnI(-) group(n=96).According to cTnI concentration of admission and symptom remission, the patients were divided into cTnI are all positive before and after treatment(n=13) ( all positive group),positive to negative after treatment(n=11) ( positive to negative group ),all negative before and after treatment(n=96) ( all negative group) three groups. According to the prognosis of in-hospital and twelve- month after discharge, the patients were divided into death group (n=19) and survival group (n=101) two groups.The time of symptom remission,re-inhospital frequency and mortality of the one-,three-,six-,twelve- month after discharge were recorded . The correlationship of change and level and prognosis,basis etiology of cardiac troponin I(cTnI),Brain natriuretic peptide(BNP) were analysed in different groups. Results 1. The change of concentration and concentration of cTnI on admission and at the time of symptom remission were Compared In different etiology and cTnI groups :①Compared with VHD,DCM,HHD three groups, the concentration of cTnI of IHD group on admission were all increased significantly (all P<0.01);remain groups were Compared have no statistics significance.②Compared with VHD,HHD three groups, The concentration of cTnI of IHD group at the time of symptom remission were all increased significantly (p<0.01,0.05 respectively);remain groups groups were Compared have no statistics significance.③Compared with on admission, the concentration of cTnI in IHD,VHD,HHD three groups patients at the time of symptom remission all decrease obviously. (p<0.01,<0.05,<0.01 respectively);However DCM group patients decrease no obviously.④The concentration of cTnI of cTnI(+) group patients on admission were high. Compared with cTnI(-) group,the concentration of cTnI in cTnI(+) group patients on admission at the time of symptom remission were still higher. (p<0.01).⑤Compared with on admission, the concentration of cTnI in cTnI(+) group and cTnI(-) group patients at the time of symptom remission all all decrease obviously. (all p<0.01).2. The time of symptom remission were Compared In different etiology groups and In different cTnI groups:①The time of symptom remission of IHD,VHD,DCM,HHD four groups were Compared have no statistics significance( all p>0.05).②Compared with cTnI(-) group,the time of symptom remission of cTnI(+) group patients were longer obviously(P<0.01),and the cTnI concentrations on admission and the time of symptom remission were positive linear related,correlation coefficient is 0.373. 3. The change of concentration and concentration of BNP on admission and at the time of symptom remission were Compared In different etiology and cTnI groups :①The concentration of BNP on admission and at the time of symptom remission in IHD,VHD,DCM,HHD four group patients have no obvious difference( all p>0.05).②Compared with on admission, the concentration of BNP in IHD,VHD,DCM,HHD four groups patients at the time of symptom remission all decrease obviously.(all p<0.01).③The concentration of BNP of cTnI(+) group patients on admission and at the time of symptom remission was all high, Compared with cTnI(-) group(p<0.01,<0.05 respectively);④Compared with on admission, the concentration of BNP in cTnI(+) group and cTnI(-) group patients at the time of symptom remission all decrease obviously. (all p<0.01).4. The correlationship of the change of concentration and concentration of cTnI and prognosis:①The in-hospital mortality of cTnI(+) group was higher than cTnI(-) group (p<0.01),the discharge mortality of cTnI(+) group was higher significantly than cTnI(-) group in one-,twelve-month after discharge,the total mortality of twelve-month after discharge and in-hospital(p<0.01 respectively). Re-inhospital rate of cTnI(+) group patients on admission in one-,three-,six-,twelve-month after discharge was higher significantly than cTnI(-) group ( all p<0.01).②The total cardiac mortality of cTnI were all positive before and after treatment group including in-hospital and 12 months after discharge was significantly higher than all negative group(all p<0.01).However positive to negative group and all negative group,all positive before and positive to negative groups were Compared have no statistics significance(p>0.05).5. The value of determine prognosis and the correlationship of concentration of cTnI and BNP on admission :①The concentration of cTnI on admission was positive related to the concentration of BNP on admission ,correlation coefficient was 0.522.②Compared with survival group, the concentration of cTnI and BNP on admission of death group patients were higher(all p<0.01).③The value of cTnI and BNP determine prognosis:The areas under ROC curve of cTnI,BNP to predict cardiac death were 0.843,0.897.respectively. cTnI and BNP had predictive values for the patients(p<0.01).The optimal cutoff value of cTnI to predict cardiac death event was 0.40ng/ml,with a sensitivity of 47.4%, and a specificity of 85.1%;the positive predictive value was 37.5% and the negative predictive value was 89.6%,with an accuracy of 79.2%.Conclusion 1. Compared with VHD,DCM,HHD three groups, the concentration of cTnI of IHD group on admission were all increased significantly.However the concentration of BNP is irrelated with etiology. 2. The venous blood concentration of cTnI on admission(0.40ng/ml) were independent predictors for mortality during hospitalization and death and re-inhospital rate of in twelve-month after discharge in AHF patients. 3. AHF patients with cTnI(+) on admission have a bad prognosis, beside on admission, these patients with cTnI(+) at symptom have a worse prognosis. 4. The concentration of cTnI on admission was positive related to the concentration of BNP on admission,cTnI and BNP had predictive values for the patients,and predictive capacity of cTnI was higher than BNP .5. The optimal cutoff value of cTnI to predict cardiac death event was 0.40ng/ml,its sensitivity was lower,but its specificity and the negative predictive value was high.
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