Takeaway
- Elevated high sensitivity troponin T (hsTnT) level is consistently associated with risk for heart failure (HF) in older men, and HF rarely occurs when baseline hsTnT level is near the detection limit.
- Although useful in HF prediction when added to traditional risk factors, TnT does not improve HF prediction when added to N-terminal pro-B-type natriuretic peptide (NT-proBNP).
Why this matters
- Circulating cardiac troponin levels are excellent biomarkers for myocardial injury, including ischaemia.
- Findings suggest that subclinical myocardial damage may be an important risk factor for HF even in individuals without diagnosed coronary heart disease.
Study design
- The British Regional Heart Study of 3852 men (aged 60-79 years) without baseline HF was followed up for a median of 12.6 years.
- Funding: The British Heart Foundation Programme grant.
Results
- During median follow-up, 295 (7.7%) incident cases of HF were reported.
- After adjustment for classical risk factors (HR, 1.58; P<.001) and NT-proBNP (HR, 1.34; P<.001), per 1 SD increase in log-transformed hsTnT was associated with higher risk for incident HF.
- Patients with baseline hsTnT levels (<5 ng/L) had a sensitivity of 99.7% (95% CI, 98.1%-99.9%) and a specificity of 3.4% (95% CI, 2.8%-4.0%).
- HF risk score based on classical risk factors and NT-proBNP yielded a c-index of 0.791, but the addition of hsTnT did not improve HF prediction (P=.28).
Limitations
- Likelihood of misclassification of outcomes including under-reporting of incident HF.
References
References