Prognostic comparison of different sensitivity cardiac troponin assays in stable heart failure
Justin L Grodin1, Sarah Neale1, Yuping Wu2
1Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
Insights
High-sensitivity cardiac troponin T (hs-cTnT) assays offer superior prognostic value for predicting mortality in chronic heart failure patients compared to standard assays. This improved accuracy is independent of other biomarkers and renal function.
Area of Science:
- Cardiology
- Biomarkers
- Prognostics
Background:
- Cardiac troponin (cTn) levels are crucial for prognostication in heart failure patients.
- Highly sensitive assays detect lower cTn levels than standard assays.
- The prognostic value of high-sensitivity assays in chronic heart failure is under investigation.
Purpose of the Study:
- To compare the prognostic value of high-sensitivity troponin T (hs-cTnT) with standard troponin I (cTnI) in patients with chronic heart failure.
- To determine if hs-cTnT provides better prediction of all-cause mortality.
Main Methods:
- Measured hs-cTnT, standard cTnI, and NT-proBNP in 504 stable heart failure patients.
- Patients underwent elective coronary angiography and were followed for 5-year all-cause mortality.
- Statistical analyses included head-to-head comparisons of prognostic utility.
Main Results:
- hs-cTnT demonstrated increased prognostic utility over cTnI (AUC 69.4% vs. 66.1%, P=.03).
- Higher hs-cTnT levels were independently associated with a 2-fold increase in 5-year mortality risk.
- hs-cTnT provided significant improvements in discrimination and reclassification of mortality risk.
Conclusions:
- High-sensitivity assays detect cardiac troponin in more chronic heart failure patients than standard assays.
- hs-cTnT offers independent and superior prognostic accuracy for mortality prediction in chronic heart failure.
Background:
Cardiac troponin (cTn) levels offer prognostic information for patients with heart failure. Highly sensitive assays detect levels of cTn much lower than the 99th percentile of standard cTn assays. We hypothesize that cardiac troponin levels measured by a high-sensitivity assay provide better prognostic value compared with cTn levels measured by a standard assay in patients with chronic heart failure.
Methods:
We measured high-sensitivity cTnT (hs-cTnT) and standard cardiac troponin I (cTnI) levels, as well as amino-terminal pro B-type natriuretic peptide (NT-proBNP) in 504 sequential stable patients with a history of heart failure who underwent elective coronary angiography, without acute coronary syndrome, and with 5-year follow-up of all-cause mortality.
Results:
The median hs-cTnT level was 21.2 (interquartile range 12.3-40.9) ng/L and 170 subjects died over 5 years. In a head-to-head overall comparison, hs-cTnT provided increased prognostic utility compared with cTnI (area under the curve [AUC] 66.1% and AUC 69.4%, respectively, P = .03; 9.0% integrated discrimination improvement, P < .001; and 13.6% event-specific reclassification, P < .001), and was independent of NT-proBNP and renal function. Even within the subset of patients where cTn levels by both assays were above the limit of quantification, higher hs-cTnT is associated with a 2-fold increase in 5-year mortality risk after adjusting for traditional risk factors (tertile 1 vs 3: hazard ratio [95% confidence interval] 2.0 [1.3-3.2]; P = .0002).
Conclusion:
Cardiac troponin can be detected by the high-sensitivity assay in more patients with chronic heart failure than the standard assay, and may yield independent and better prognostic accuracy for mortality prediction than standard assay.
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