High-sensitivity troponin I and amino-terminal pro--B-type natriuretic peptide predict heart failure and mortality in the general population

• Published in: Clinical chemistry (Baltimore, Md.) Vol. 60; no. 9; pp. 1225 - 1233
• Main Authors: McKie, Paul M, AbouEzzeddine, Omar F, Scott, Christopher G, Mehta, Ramila, Rodeheffer, Richard J, Redfield, Margaret M, Burnett, Jr, John C, Jaffe, Allan S
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 01.09.2014
• Subjects: Cardiology; Cardiovascular disease; Cardiovascular Diseases - blood; Cardiovascular Diseases - mortality; Epidemiology; Female; Heart attacks; Heart failure; Humans; Hypertension; Limit of Detection; Male; Medical records; Middle Aged; Mortality; Natriuretic Peptide, Brain - blood; Older people; Peptide Fragments - blood; Population; Predictive Value of Tests; Risk Assessment; Troponin T - blood; Ultrasonic imaging; Minnesota
• ISSN: 0009-9147; 1530-8561
• DOI: 10.1373/clinchem.2014.222778

High-sensitivity cardiac troponin assays have potent prognostic value in stable cardiovascular disease cohorts. Our objective was to assess the prognostic utility of a novel cardiac troponin I (cTnI) high-sensitivity assay, independently and in combination with amino-terminal pro-B-type natriuretic peptide (NT-proBNP), for the future development of heart failure and mortality in the general community. A well-characterized community-based cohort of 2042 participants underwent clinical assessment and echocardiographic evaluation. Baseline measurements of cTnI with a high-sensitivity assay and NT-proBNP were obtained in 1843 individuals. Participants were followed for new-onset heart failure and mortality with median (25th, 75th percentile) follow-up of 10.7 (7.9, 11.6) and 12.1 (10.4, 13.0) years, respectively. When measured with a high-sensitivity assay, cTnI greater than the sex-specific 80th percentile was independently predictive of heart failure [hazard ratio 2.56 (95% confidence interval 1.88-3.50), P < 0.001] and mortality [1.91(1.49-2.46), P < 0.001] beyond conventional risk factors in this community-based cohort, with significant increases in the net reclassification improvement for heart failure. The prognostic utility of cTnI measured with a high-sensitivity assay goes beyond NT-proBNP, yet our data suggest that these 2 assays are complementary and most beneficial when evaluated together in identifying at-risk individuals in the community. Our findings lay the foundation for prospective studies aimed at identification of individuals at high risk by use of a multimarker approach, followed by aggressive prevention strategies to prevent subsequent heart failure.