Ravi H Parikh1, Stephen L Seliger2, James de Lemos3, Vijay Nambi4, Robert Christenson5, Colby Ayers6, Wensheng Sun7, John S Gottdiener1, Lewis H Kuller8, Christie Ballantyne7, Christopher R deFilippi9. 1. Department of Medicine, Division of Cardiovascular Medicine, University of Maryland School of Medicine, Baltimore, MD; 2. Department of Medicine, Division of Nephrology, University of Maryland School of Medicine, Baltimore, MD; 3. Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX; 4. Department of Medicine, Baylor College of Medicine, Center for Cardiovascular Disease Prevention, Methodist DeBakey Heart and Vascular Center, Michael E. DeBakey Veterans Affairs Hospital, Houston, TX; 5. Department of Pathology, University of Maryland School of Medicine, Baltimore, MD; 6. Department of Internal Medicine, Department of Clinical Science, University of Texas Southwestern Medical Center, Dallas, TX; 7. Department of Medicine, Baylor College of Medicine, Center for Cardiovascular Disease Prevention, Methodist DeBakey Heart and Vascular Center, Houston, TX; 8. Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA. 9. Department of Medicine, Division of Cardiovascular Medicine, University of Maryland School of Medicine, Baltimore, MD; cdefilip@medicine.umaryland.edu.
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).
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).
Authors: Stephen L Seliger; Susie N Hong; Robert H Christenson; Richard Kronmal; Lori B Daniels; Joao A C Lima; James A de Lemos; Alain Bertoni; Christopher R deFilippi Journal: Circulation Date: 2017-02-03 Impact factor: 29.690
Authors: Jeanney Lew; Monika Sanghavi; Colby R Ayers; Darren K McGuire; Torbjørn Omland; Dorothee Atzler; Maria O Gore; Ian Neeland; Jarett D Berry; Amit Khera; Anand Rohatgi; James A de Lemos Journal: Circulation Date: 2017-02-07 Impact factor: 29.690
Authors: Menglu Liang; John William McEvoy; Yuan Chen; A Richey Sharrett; Elizabeth Selvin Journal: Diabetes Care Date: 2016-08-01 Impact factor: 19.112
Authors: Yader Sandoval; Suzette J Bielinski; Lori B Daniels; Michael J Blaha; Erin D Michos; Andrew P DeFilippis; Moyses Szklo; Christopher deFilippi; Nicholas B Larson; Paul A Decker; Allan S Jaffe Journal: J Am Coll Cardiol Date: 2020-07-28 Impact factor: 24.094
Authors: Lewis H Kuller; Oscar L Lopez; John S Gottdiener; Dalane W Kitzman; James T Becker; Yuefang Chang; Anne B Newman Journal: J Am Heart Assoc Date: 2017-07-22 Impact factor: 5.501
Authors: Olena Iakunchykova; Maria Averina; Alexander V Kudryavtsev; Tom Wilsgaard; Andrey Soloviev; Henrik Schirmer; Sarah Cook; David A Leon Journal: J Am Heart Assoc Date: 2019-12-18 Impact factor: 5.501