Elevated high-sensitivity cardiac troponin predicts incident HF
High-sensitivity cardiac troponin levels were strongly associated with the risk for incident HF, according to a meta-analysis published in JACC: Heart Failure.
Jonathan D. W. Evans, MBChB, BHF Cambridge CRE Clinical Research Training Fellow in the department of public health and primary care at University of Cambridge, and colleagues analyzed data from 67,063 participants (mean age, 57 years; 47% women) without HF at baseline from 16 prospective studies that measured high-sensitivity cardiac troponin and recorded incident HF events for at least 1 year. Studies that involved patients in the early phase after an acute MI, those with established multisystem or myocardial disease, or those underdoing cardiotoxic chemotherapy were excluded.
During follow-up, 4,165 incident HF events occurred. The studies included in the meta-analysis were of high quality, according to the Newcastle-Ottawa score (8.2 of 9).
Compared with those who had high-sensitivity cardiac troponin concentration in the bottom third, those in the top third had elevated risk for incident HF (HR = 2.09; 95% CI, 1.76-2.48). Significant heterogeneity was evident (80%; 95% CI, 68-87).
The results were consistent in men (HR = 2.29; 95% CI, 1.64-3.21) and women (HR = 2.18; 95% CI, 1.68-2.81), and for high-sensitivity cardiac troponin T (HR = 2.11; 95% CI, 1.69-2.63) and high-sensitivity cardiac troponin I (HR = 2.09; 95% CI, 1.53-2.85). After adjusting for B-type natriuretic peptide, the HR was 2.08 (95% CI, 1.64-2.65).
Adding high-sensitivity cardiac troponin to conventional risk factors improved the C index between 1% and 3%, Evans and colleagues wrote.
“Preliminary data showing discrimination improvements in HF risk with [high-sensitivity cardiac troponin] assessment suggest that it may be a promising biomarker for measurement as part of primary prevention of HF,” Evans and colleagues wrote.
“As advocates for biomarker use in patients with HF and from our previous studies, we appreciate the interesting proof of concept presented by Evans et al, and with which we concur in regard to establishing estimates of those at risk for HF going forward,” Allan S. Jaffe, MD, FACC, FAHA, FESC, professor of medicine, professor of laboratory medicine and pathology, and chair of the division of clinical core laboratory services at Mayo Clinic and a member of the Cardiology Today Editorial Board, and Wayne L. Miller, MD, PhD, professor in the department of cardiovascular medicine at Mayo Clinic and Foundation, wrote in a related editorial. “However, we also have tried to use this opportunity to suggest that the field needs to spend additional time and effort refining the specific techniques that might more fully optimize the ability to use summary and meta-analyses that include biomarkers.” – by Darlene Dobkowski
Disclosures: The authors and Miller report no relevant financial disclosures. Jaffe reports he has consulted for most of the major diagnostic companies either presently or in the past.