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High-Sensitivity Cardiac Troponin I Levels and Prediction of Heart Failure: Results From the BiomarCaRE Consortium
Isabell Yan1, Christin S Börschel2, Johannes T Neumann2
1Department of Cardiology, University Heart and Vascular Centre Hamburg, Hamburg, Germany.
Insights
High-sensitivity cardiac troponin I (hs-cTnI) is independently associated with heart failure (HF) risk. This biomarker improves prediction beyond traditional risk factors and N-terminal pro-B-type natriuretic peptide, aiding early identification.
Area of Science:
- Cardiology
- Biomarker Research
- Epidemiology
Background:
- Heart failure (HF) significantly contributes to the global burden of cardiovascular disease.
- Early identification of individuals at risk for HF is crucial for implementing preventive strategies.
Purpose of the Study:
- To characterize the association between high-sensitivity cardiac troponin I (hs-cTnI) and incident heart failure (HF).
- To evaluate the predictive value of hs-cTnI beyond established cardiovascular risk factors (CVRFs) and N-terminal pro-B-type natriuretic peptide.
- To derive clinical cutoff values for hs-cTnI in risk stratification for HF.
Main Methods:
- Analysis of individual-level data from 4 prospective population-based cohorts (n=48,455) within the Biomarker for Cardiovascular Risk Assessment in Europe consortium.
- Exclusion of participants with prevalent myocardial infarction, HF, or stroke at baseline.
- Utilized Cox proportional hazards models, C-statistics, and Brier scores to assess the incremental predictive value of hs-cTnI.
Main Results:
- Elevated hs-cTnI levels were significantly associated with an increased risk of incident HF (HR 1.42 per log unit change).
- The addition of hs-cTnI to CVRFs and N-terminal pro-B-type natriuretic peptide significantly improved HF prediction (C-index = 0.862).
- Optimal hs-cTnI cutoff values were identified: 2.6 ng/l for women and 4.2 ng/l for men.
Conclusions:
- High-sensitivity cardiac troponin I is an independent predictor of incident heart failure in the general population.
- hs-cTnI enhances risk prediction for HF, offering value beyond traditional risk factors and NT-proBNP.
- Derived hs-cTnI cutoffs can aid in identifying individuals at higher risk for HF, facilitating targeted preventive interventions.
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.