High-Sensitivity Cardiac Troponin I Levels and Prediction of Heart Failure
Isabell Yan, Christin S. Börschel, Franz‐Josef Neumann, Ngoc Anh Sprünker, Nataliya Makarova, Jukka Kontto, Kari Kuulasmaa, Veikko Salomaa, Christina Magnussen, Licia Iacoviello, Augusto Di Castelnuovo, Simona Costanzo, Allan Linneberg, Stefan Söderberg, Tanja Zeller, Francisco Ojeda, Stefan Blankenberg, Dirk Westermann
Abstract
OBJECTIVES: The aims of this study were to characterize the association of high-sensitivity cardiac troponin I (hs-cTnI) with heart failure (HF), to determine its predictive value beyond classical cardiovascular risk factors (CVRFs) and N-terminal pro-B-type natriuretic peptide, and to derive a relevant cutoff for potential clinical application. BACKGROUND: HF is an important contributor to the overall burden of cardiovascular disease. Early identification of individuals at risk could be beneficial for preventive therapies. METHODS: Based on the Biomarker for Cardiovascular Risk Assessment in Europe consortium, we analyzed individual-level data from 4 prospective population-based cohort studies including 48,455 individuals. Participants with myocardial infarction, HF, and stroke at baseline were excluded. We investigated the value of adding hs-cTnI to CVRFs and N-terminal pro-B-type natriuretic peptide using Cox proportional hazards survival models and for prediction by calculating C-statistics and Brier score. RESULTS: The median age of the study population was 51 years, and the median follow-up time for occurrence of HF was 6.61 years. Cox regression models adjusted for age, sex, and CVRFs revealed a significant association of hs-cTnI with incident HF (hazard ratio: 1.42 per log [ng/l] unit change [95% confidence interval: 1.31 to 1.53]). The best predictive value was achieved in the model with CVRFs (base model) and both biomarkers (C-index = 0.862; 95% confidence interval: 0.841 to 0.882). Optimal hs-cTnI cutoff values of 2.6 ng/l for women and 4.2 ng/l for men were derived for selecting individuals at risk. CONCLUSIONS: In this large dataset from the general population, hs-cTnI could show its independence for the prognosis of HF.