https://imcjms.com Ibrahim Medical College Journal of Medical Science https://imcjms.com/registration/journal_full_text/62 Tue, 02 Aug 2016 11:45:56 +0000 Ibrahim Med. Coll. J. 2013; 7(2): 32-34   Introduction The predictors of adverse outcomes in acute heart failure are - older age, male gender, increased serum cardiac troponin-I (cTn-I), lower systolic blood pressure, increased serum cystatin - C, renal failure.3 Recently cTn-I has also been proposed as a diagnostic and prognostic marker of acute heart failure. Increased cTn-I appears to be a sensitive and specific risk factor of complications in acute heart failure.6 Patients with an elevated cTn-I (³ 1.0 ng/ml) had lower systolic blood pressure and a lower ejection fraction than those who had normal cTn-I.7 Researchers also suggested that early risk stratification of positive cTn-I patients could result in better management in terms of treatment and follow-up monitoring.   A total of 100 acute heart failures cases were selected purposively from the patients admitted in Cardiac Coronary Care Unit of Dhaka Medical College Hospital and National Institute of Cardiovascular Diseases (NICVD), Dhaka, from January 2010 to December 2010. The acute heart failure was diagnosed by physical examination, ECG and echocardiography. Detail clinical history and all information were recorded in a pre-designed data collection sheet. Serum cTn-I level was estimated in all study population. Based on the serum CTn-I level, the study population was divided into two groups. Group A consisted of patients having serum cTn-I level of ³ 1.0 ng/ml while group B had cTn-I level < 1.0 ng/ml. Both the study groups were followed during the hospital stay to observe the outcomes. Values of different parameters were compared to see the difference between two groups by using student’s t test, chi-square test & Fisher exact test. Written informed consents were obtained from all patients. Results Table-1 shows that significantly high (P<0.05) number of group A (28%) patients in comparison to group B (10%) suffered from left ventricular systolic dysfunction (lower ejection fraction) as diagnosed by echocardiography during their hospital stay time. Renal failure was observed in 10 (20%) group A and 2 (4%) group B study subjects (P<0.05). Similarly, impaired liver function was higher in group A (22%) compared to group B (8%) patients but was not statistically significant (P > 0.05). During the hospital stay, electrolyte imbalance was observed in 26.0% of group A compared to 4% of group B cases (P<0.004). Table-1: The rate of complications in acute heart failure cases having elevated and normal serum cTn-I level (n=50)     There are different predictors of adverse outcomes in acute heart failure cases. Cardiac troponin-I has been found to be a better marker of adverse outcomes by many workers.8,9 Recently, cardiac troponin- I was also proposed as a diagnostic and prognostic marker in acute heart failure.6 So, the present study was aimed to evaluate cTn-I as a predictor of outcomes of acute heart failure. Acute heart failure is a clinical emergency that might be fatal in some instances. Prognosis depends on many associated clinical conditions and institution of prompt treatment. A single specific easily measurable biochemical marker like serum cTn-I could a play role in the better management of the patients. Therefore, estimation of serum cTn-I in acute heart failure cases may be recommended to categorize patients for their proper management.   1.    Newby DE, Grubb NR and Bradbury A. Cardiovascular disease, in Nicki R. Colledge, Brian R. Walker, Stuart H. Ralston (eds), Davidson’s principles & practice of Medicine 2010; 21th edn, Churchill livingstone Elseveir, Philadelphia, USA,   543-550. 3.    Ilva T, Lassus J, Waris KS, Melin J, Peuhkurinen K, Pulkki K et al. Clinical significance of cardiac troponins I and T in acute heart failure. European journal of heart failure, 2008; 10: 772-779. 5.    Grewal J and Gin K. Troponin, Marks the spot. Perspectives in cardiology, 2004; 35-40. 7.    Peacock WF, Marco TD, Fonarow GC, Diercks D, Wynne J, Apple FS and Wu AHB. Cardiac Troponin and Outcome in acute heart failure. N ENGL J MED, 2008; 358(20): 2117-26. 9.    Sukova J, Ostadal P, Diercks D and Widimsky P. Profile of the patients with acute heart failure and  elevated troponin I levels. Exp Clin Cardiol, 2007; 12(3): 153-156. 2026 Ibrahim Medical College. All rights reserved.