High-Sensitivity Cardiac Troponin I Levels and Prediction of Heart Failure: Results From the BiomarCaRE Consortium

Isabell Yan, Christin S Börschel, Johannes T Neumann, Ngoc A 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 M Ojeda-Echevarria, Stefan Blankenberg, Dirk Westermann

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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.

Original languageEnglish
Pages (from-to)401-411
Number of pages11
JournalJACC: Heart Failure
Issue number5
Publication statusPublished - May 2020


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