Isabell Yan1, Christin S Börschel2, Johannes T Neumann2, Ngoc A Sprünker1, Nataliya Makarova2, Jukka Kontto3, Kari Kuulasmaa3, Veikko Salomaa3, Christina Magnussen2, Licia Iacoviello4, Augusto Di Castelnuovo5, Simona Costanzo6, Allan Linneberg7, Stefan Söderberg8, Tanja Zeller2, Francisco M Ojeda-Echevarria1, Stefan Blankenberg2, Dirk Westermann9. 1. Department of Cardiology, University Heart and Vascular Centre Hamburg, Hamburg, Germany. 2. Department of Cardiology, University Heart and Vascular Centre Hamburg, Hamburg, Germany; German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck, Hamburg, Germany. 3. National Institute for Health and Welfare, Helsinki, Finland. 4. Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Italy; Research Center in Epidemiology and Preventive Medicine, Department of Medicine and Surgery, University of Insubria, Varese, Italy. 5. Mediterranea Cardiocentro, Napoli, Italy. 6. Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Italy. 7. Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Center for Clinical Research and Disease Prevention, Bispebjerg and Frederiksberg Hospital, The Capital Region, Copenhagen, Denmark. 8. Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden. 9. Department of Cardiology, University Heart and Vascular Centre Hamburg, Hamburg, Germany; German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck, Hamburg, Germany. Electronic address: d.westermann@uke.de.
Abstract
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.
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.
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