High-sensitivity troponins for outcome prediction in the general population: a systematic review and meta-analysis
Alberto Aimo1, Georgios Georgiopoulos2, Giorgia Panichella3
1Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy; Fondazione Toscana Gabriele Monasterio, Pisa, Italy.
Insights
High-sensitivity cardiac troponin (hs-cTn) levels in the general population predict future health risks. Elevated hs-cTnT or hs-cTnI indicates cardiomyocyte damage and increases the likelihood of cardiovascular events and mortality.
Area of Science:
- Cardiology
- Biomarkers
- Preventive Medicine
Background:
- High-sensitivity assays enable measurement of cardiac troponin T and I (hs-cTnT/I) in individuals without overt cardiac disease.
- Elevated hs-cTn levels correlate with ongoing cardiomyocyte damage and increased risk of symptomatic cardiac conditions.
Purpose of the Study:
- To evaluate the prognostic significance of hs-cTnT and hs-cTnI in the general population.
- To quantify the association between hs-cTn levels and adverse cardiovascular outcomes.
Main Methods:
- Systematic review and meta-analysis of studies assessing the prognostic value of hs-cTnT or hs-cTnI.
- Pooled hazard ratios (HR) calculated for all-cause death, cardiovascular death, cardiovascular events, and heart failure hospitalization.
Main Results:
- Analysis of 24 studies with over 200,000 participants.
- A one SD increase in hs-cTn was linked to a 23% higher risk of all-cause death (primarily from hs-cTnI studies).
- hs-cTn significantly predicted cardiovascular death, cardiovascular events, and heart failure hospitalization, with both hs-cTnT and hs-cTnI showing prognostic value.
Conclusions:
- hs-cTn measurements provide robust prognostic information in the general population.
- Elevated hs-cTn levels are associated with increased risks of mortality, cardiovascular events, and heart failure hospitalization.
Background:
High-sensitivity (hs) assays allow to measure cardiac troponin T and I (cTnT/I) even in healthy individuals. The higher hs-cTn values, the higher the ongoing cardiomyocyte damage, and then reasonably the risk of developing symptomatic cardiac disease.
Methods:
We retrieved all studies evaluating the prognostic value of hs-cTnT or I in the general population. We calculated pooled hazard ratio (HR) values for all-cause and cardiovascular death, cardiovascular events and heart failure (HF) hospitalization.
Results:
We included 24 studies for a total of 203,202 subjects; 11 studies assessed hs-cTnT and 14 hs-cTnI. One standard deviation (SD) increase in baseline hs-cTn was associated with a 23% higher risk of all-cause death (HR 1.226, 95% CI 1.083-1.388, p<0.001, I2=88.5%); all these studies measured hs-cTnI. In an exploratory analysis on 3 studies with 25,760 subjects, hs-cTn predicted cardiovascular death (HR 1.822, 95% CI 1.241-2.674, p=0.002, I2=87.2%). After synthesizing 9 studies with 58,565 subjects, hs-cTn predicted cardiovascular events (HR 1.328, 95% CI 1.167-1.513, p<0.001, I2=93.8%). Both hs-cTnT (HR 1.627, 95% CI 1.145-2.311, p<0.001) and hs-cTnI (HR 1.260, 95% CI 1.115-1.423, p<0.001; p for interaction <0.001). Furthermore, in 10 studies with 61,467 subjects, hs-cTn predicted HF hospitalization (HR 1.493, 95% CI 1.368-1.630, p<0.001, I2=76.6%). Both hs-cTnT (HR 1.566, 95% CI 1.303-1.883, p<0.001) and hs-cTnI (HR 1.467, 95% CI 1.321-1.628, p<0.001) were associated with HF hospitalization (p for interaction <0.001).
Conclusions:
hs-cTn values hold strong prognostic value in subjects from the general population, predicting the risk of all-cause and cardiovascular mortality, cardiovascular events, and HF hospitalization.
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