Abstract 16145: Significance of High-sensitivity Cardiac Troponin T Levels Between the Limit of Blank and the Limit of Detection in the General Population: A Meta-analysis

Introduction: A substantial minority of asymptomatic individuals will have very low but measurable levels of cardiac troponin T using a high sensitive assay (hs-cTnT). It is controversial if levels in this range provide physiologic and prognostic information. We hypothesized that hs-cTnT levels between the limit of blank (LOB) (3 ng/L) and limit of detection (LOD) (5 ng/L) are associated with increased incidence of heart failure (HF) and cardiovascular death compared to levels below the LOB (<3 ng/L). Methods: hs-cTnT was measured in subjects without prevalent HF from the Cardiovascular Health Study (CHS), Atherosclerosis Risk in Communities (ARIC) study, and Dallas Heart Study (DHS). Participants were divided into two groups: levels below the LOB (n=7272) and levels between the LOB and LOD (n=3451). Cross sectional and longitudinal associations with demographics, traditional cardiovascular risk factors, and cardiovascular outcomes were made. A fixed-effect meta-analysis was performed using regression coefficients and variance estimates from fully adjusted models from all three cohorts. Results: Participants with hs-cTnT between the LOB and LOD were older, more likely to be male, and had higher prevalence of cardiovascular risk factors and structural abnormalities such as higher coronary artery calcium score and left ventricular mass. A meta-analysis of the three cohorts showed participants with hs-cTnT between the LOB and LOD were at increased risk of new-onset HF (HR=1.18, 95% CI: 1.02, 1.38) and cardiovascular death (HR=1.29, 95% CI: 1.06, 1.57) after adjusting for demographics and traditional risk factors when compared to participants with hs-cTnT below the LOB (Figure). Conclusions: hs-cTnT levels between the LOB and LOD are associated with a higher prevalence of traditional risk factors, cardiac pathology, and worse outcomes compared with levels below the LOB. Therefore, in general population cohorts, hs-cTnT should be reported down to the LOB.

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Prognostic Significance of High-Sensitivity Cardiac Troponin T Concentrations between the Limit of Blank and Limit of Detection in Community-Dwelling Adults: A Metaanalysis

Clinical Chemistry ◽

10.1373/clinchem.2015.244160 ◽

2015 ◽

Vol 61 (12) ◽

pp. 1524-1531 ◽

Cited By ~ 26

Author(s):

Ravi H Parikh ◽

Stephen L Seliger ◽

James de Lemos ◽

Vijay Nambi ◽

Robert Christenson ◽

...

Keyword(s):

Risk Factors ◽

Heart Failure ◽

Cardiovascular Risk ◽

Cardiovascular Risk Factors ◽

Cardiac Troponin ◽

Limit Of Detection ◽

Troponin T ◽

High Sensitivity ◽

Hazard Ratio ◽

Cardiac Troponin T

Abstract BACKGROUND There is controversy regarding whether to report concentrations of high-sensitivity cardiac troponin T (hs-cTnT) to the limit of blank (LOB) (3 ng/L) or the limit of detection (LOD) (5 ng/L) of the assay in community-based cohorts. We hypothesized that hs-cTnT concentrations between the LOB and LOD would be associated with poorer cardiovascular outcomes compared to concentrations below the LOB. METHODS hs-cTnT was analyzed in a total of 10 723 participants from the Cardiovascular Health Study (CHS), Atherosclerosis Risk in Communities (ARIC) study, and Dallas Heart Study (DHS). Participants were divided into 2 groups, those with hs-cTnT concentrations below the limit of blank (LOB) (<3 ng/L) and those with hs-cTnT between the LOB and limit of detection (LOD) (3–4.99 ng/L). Cross-sectional associations with traditional cardiovascular risk factors and cardiac structural measurements, and longitudinal associations with long-term cardiovascular outcomes of incident heart failure and cardiovascular death, were determined. RESULTS Participants with hs-cTnT between the LOB and LOD for all 3 cohorts were older, more likely to be male, and have a higher burden of cardiovascular risk factors and structural pathology. A metaanalysis of the 3 cohorts showed participants with hs-cTnT between the LOB and LOD were at increased risk of new-onset heart failure (hazard ratio, 1.18; 95% CI, 1.02–1.38) and cardiovascular mortality (hazard ratio, 1.29; 95% CI, 1.06–1.57). CONCLUSIONS hs-cTnT concentrations between the LOB and LOD (3–4.99 ng/L) are associated with a higher prevalence of traditional risk factors, more cardiac pathology, and worse outcomes than concentrations below the LOB (<3 ng/L).

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High-sensitive cardiac troponin T and its relations to cardiovascular risk factors, morbidity, and mortality in elderly men

American Heart Journal ◽

10.1016/j.ahj.2013.07.004 ◽

2013 ◽

Vol 166 (3) ◽

pp. 541-548.e1 ◽

Cited By ~ 28

Author(s):

Kai M. Eggers ◽

Jinan Al-Shakarchi ◽

Lars Berglund ◽

Bertil Lindahl ◽

Agneta Siegbahn ◽

...

Keyword(s):

Risk Factors ◽

Cardiovascular Risk ◽

Cardiovascular Risk Factors ◽

Cardiac Troponin ◽

Troponin T ◽

Morbidity And Mortality ◽

Cardiac Troponin T ◽

Elderly Men

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Utility of Highly Sensitive Cardiac Troponin T Assay for Evaluation of Cardiovascular Risk in General Population

Journal of Cardiac Failure ◽

10.1016/j.cardfail.2009.07.049 ◽

2009 ◽

Vol 15 (7) ◽

pp. S161

Author(s):

Shigeru Matsui ◽

Junnichi Ishii ◽

Tousei Hashimoto ◽

Masanori Okumura ◽

Tadashi Nakano ◽

...

Keyword(s):

Cardiovascular Risk ◽

General Population ◽

Cardiac Troponin ◽

Troponin T ◽

Cardiac Troponin T ◽

Highly Sensitive

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Comparison between High-Sensitivity Cardiac Troponin T and Cardiac Troponin I in a Large General Population Cohort

Clinical Chemistry ◽

10.1373/clinchem.2018.292086 ◽

2018 ◽

Vol 64 (11) ◽

pp. 1607-1616 ◽

Cited By ~ 35

Author(s):

Paul Welsh ◽

David Preiss ◽

Anoop S V Shah ◽

David McAllister ◽

Andrew Briggs ◽

...

Keyword(s):

Risk Factors ◽

Cardiovascular Risk ◽

General Population ◽

Cardiovascular Risk Factors ◽

Cardiac Troponin ◽

Troponin I ◽

Troponin T ◽

High Sensitivity ◽

General Population Cohort ◽

Age And Sex

Abstract BACKGROUND Few data compare cardiac troponin T (cTnT) and cardiac troponin I (cTnI) in a general population. We sought to evaluate the distribution and association between cTnT, cTnI, and cardiovascular risk factors in a large general population cohort. METHODS High-sensitivity cTnT and cTnI were measured in serum from 19501 individuals in the Generation Scotland Scottish Family Health Study. Associations with cardiovascular risk factors were compared using age- and sex-adjusted regression. Observed age- and sex-stratified 99th centiles were compared with 99th centiles for cTnT (men, 15.5 ng/L; women, 9.0 ng/L) and cTnI (men, 34.2 ng/L; women, 15.6 ng/L) used in clinical practice. RESULTS cTnT and cTnI concentrations were detectable in 53.3% and 74.8% of participants, respectively, and were modestly correlated in unadjusted analyses (R2 = 21.3%) and only weakly correlated after adjusting for age and sex (R2 = 9.5%). Cardiovascular risk factors were associated with both troponins, but in age- and sex-adjusted analyses, cTnI was more strongly associated with age, male sex, body mass index, and systolic blood pressure (P < 0.0001 for all vs cTnT). cTnT was more strongly associated with diabetes (P < 0.0001 vs cTnI). The observed 99th centiles were broadly consistent with recommended 99th centiles in younger men and women. After the age of 60 years, observed 99th centiles increased substantially for cTnT, and beyond 70 years of age, the 99th centiles approximately doubled for both troponins. CONCLUSIONS In the general population, cTnT and cTnI concentrations are weakly correlated and are differentially associated with cardiovascular risk factors. The 99th centiles currently in use are broadly appropriate for men and women up to but not beyond the age of 60 years.

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Abstract 12158: Impact of Modifiable Risk Factors on Circulating Concentrations of B-type Natriuretic Peptide and Cardiac Troponin T

Circulation ◽

10.1161/circ.132.suppl_3.12158 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Pratyaksh K Srivastava ◽

Aruna D Pradhan ◽

Nancy R Cook ◽

Paul M Ridker ◽

Brendan M Everett

Keyword(s):

Risk Factors ◽

Cardiovascular Risk ◽

Alcohol Consumption ◽

Natriuretic Peptide ◽

Cardiac Troponin ◽

Troponin T ◽

Strong Association ◽

High Sensitivity ◽

Cardiac Troponin T ◽

Substantial Impact

Introduction: Alcohol use, physical activity, diet, and cigarette smoking are modifiable cardiovascular risk factors that have a substantial impact on the risk of myocardial infarction, stroke, and cardiovascular death. Hypothesis: We hypothesized that these behaviors may alter concentrations of cardiac troponin, a marker of myocyte injury, and B-type natriuretic peptide, a marker of myocyte stress. Both markers have shown strong association with adverse cardiovascular outcomes. Methods: In 564 women with no evidence of cardiovascular disease, we measured circulating concentrations of cardiac troponin T, measured using a high-sensitivity assay (hsTnT), and the N-terminal fragment of B-type natriuretic peptide (NT-proBNP). We used logistic regression to determine if these behaviors were associated with detectable hsTnT (>= 3ng/L) or with NT-proBNP in the highest quartile (≥117.4 ng/L). Results: The median (Q1-Q3) NT-proBNP of the cohort was 64.2 (37.8-117.4), and 30.3% (171/564) of the cohort had detectable circulating hsTnT. In adjusted models, women who drank 1-6 drinks per week had a lower odds of having a detectable hsTnT (OR 0.54, 95% CI: 0.33-0.89, P-trend=0.001) or an elevated NT-proBNP (OR 0.48, 95% CI 0.19-1.19, P-trend =0.03; Figure). We validated the results for B-type natriuretic peptide in a large independent cohort. No significant associations were seen for diet, exercise, or smoking. Conclusion: Regular alcohol consumption is associated with lower concentrations of hsTnT and NT-proBNP, two cardiovascular biomarkers associated with increased cardiovascular risk. These results raise the hypothesis that the beneficial effects of alcohol consumption may be mediated by direct effects on the myocardium.

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1461-P: Cardiac Troponin T and Troponin I and Incident Diabetes in the General Population: Generation Scotland Scottish Family Health Study

Diabetes ◽

10.2337/db19-1461-p ◽

2019 ◽

Vol 68 (Supplement 1) ◽

pp. 1461-P

Author(s):

PAUL WELSH ◽

DAVID PREISS ◽

ARCHIE CAMPBELL ◽

DAVID J. PORTEOUS ◽

NICHOLAS L. MILLS ◽

...

Keyword(s):

General Population ◽

Cardiac Troponin ◽

Troponin I ◽

Troponin T ◽

Family Health ◽

Incident Diabetes ◽

Health Study ◽

Cardiac Troponin T ◽

Generation Scotland

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Cardiac biomarkers for cardiovascular risk prediction among women and men from the general population

European Journal of Preventive Cardiology ◽

10.1093/eurjpc/zwab061.240 ◽

2021 ◽

Vol 28 (Supplement_1) ◽

Author(s):

F Zhu ◽

B Arshi ◽

E Aribas ◽

MA Ikram ◽

MK Ikram ◽

...

Keyword(s):

Risk Factors ◽

Coronary Heart Disease ◽

Heart Disease ◽

Cardiovascular Risk ◽

Predictive Value ◽

Troponin T ◽

Cardiac Biomarkers ◽

C Statistic ◽

Cardiovascular Risk Prediction ◽

Traditional Risk Factors

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): the Erasmus Medical Center and Erasmus University Rotterdam; the Netherlands Organization for Health Research and Development (ZonMw); Purpose To evaluate the sex-specific predictive value of two cardiac biomarkers; N-terminal pro B-type natriuretic peptide (NT-proBNP) and high sensitivity cardiac troponin T (hs-cTnT), alongside traditional cardiovascular risk factors, for 10-year cardiovascular risk prediction in general population. Methods A total of 5430 participants (mean age 68.1 years; 59.9% women) free of cardiovascular disease (CVD), with blood sample measurements between 1997 and 2001 were included. We developed a ‘base’ model using cardiovascular risk factors used in the Pooled Cohort Equation (includes age, sex, systolic blood pressure, treatment of hypertension, total and high-density lipoprotein cholesterol levels, smoking, and diabetes) and then extended the ‘base’ model with NT-proBNP or hs-cTnT. These models were developed for coronary heart disease (CHD), stroke, and heart failure (HF) and also for composite CVD outcomes. To evaluate biomarkers’ added predictive value, c-statistic, and net reclassification improvement index (NRI) for events and non-events were calculated. NRI was calculated using cutoffs of 5%, 7.5% and 20% to categorize participants as low, borderline, intermediate, or high risk. Results Adding NT-proBNP to the ‘base’ model significantly improved c-statistic for all outcomes (increases ranged between 0.012-0.047), with the largest improvement in HF [0.026 (95% CI, 0.013, 0.040) for women and 0.047 (95% CI, 0.026, 0.069) for men]. Adding hs-TnT to ‘base’ model increased the c-statistic for CHD in women by 0.040 (95% CI, 0.013, 0.067) and for HF in men by 0.032 (95% CI, 0.005, 0.059). Improvments in reclassification by both biomarkers were mostly limited to modest improvemetns in reclassification of non-events [largest non-event NRI for global CVD in women (NT-proBNP: 11.8%; hs-cTnT: 10.5%) and for HF in men (NT-proBNP: 9.6%; hs-cTnT: 8.4%)]. Conclusion NT-proBNP improved model performance for prediction of all cardiovascular outcomes, in particular for HF, beyond traditional risk factors for both women and men. Hs-cTnT showed modest added predictive value beyond traditional risk factors for CHD among women and for HF among men. Imropovements in reclassification by both biomarkers were modest and not clinically relevant. Improvements of 10-year risk predictions Events Adding NT-proBNP Adding troponin T Delta c-statistic* Event NRI, % Non-event NRI, % Delta c-statistic* Event NRI, % Non-event NRI, % WomenASCVD Global CVD 0.012 (0.004, 0.020) 0.018 (0.010, 0.026) -1.7 (-5.0, 1.5)-0.8 (-3.8, 2.2) 5.4 (3.5, 7.2)11.8 (9.6, 14.1) 0.028 (0.009, 0.048)0.025 (0.009, 0.040) -0.4 (-7.1, 6.2)2.9 (-2.4, 8.3) 6.9 (3.9, 9.9)10.5 (7.3, 13.8) MenASCVD Global CVD 0.016 (0.005, 0.027)0.023 (0.012, 0.033) 0.7 (-2.3, 3.7)-0.3 (-3.0, 2.4) 5.2 (3.2, 7.2)7.2 (4.9, 9.4) 0.007 (-0.002, 0.016)0.011 (0.000, 0.021) -1.1 (-5.0, 2.7)-1.6 (-6.0, 2.8) 4.0 (1.2, 6.9)6.4 (3.1, 9.7) ASCVD comprises coronary heart disease and stroke; Global CVD comprises coronary heart disease, stroke and heart failure.

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