Author + information
- Manan Pareeka,b,
- Deepak L. Bhatta,b,
- Muthiah Vaduganathana,b,
- Arman Qamara,b,
- Axel Diederichsena,b,
- Margrét Leósdóttira,b,
- Martin Magnussona,b,
- Peter M. Nilssona,b and
- Michael H. Olsena,b
Background: Troponin assays have improved the diagnosis, management, and prognostication of patients presenting with acute coronary syndromes. The introduction of high-sensitivity troponin-T (hs-TnT) assays has facilitated risk prediction in lower-risk cohorts. Limited data exist clarifying the prognostic potential of hs-TnT measurements in clinically stable, apparently healthy individuals.
Methods: We conducted a prospective population-based cohort study of 695 apparently healthy individuals on no cardiovascular medications, who underwent echocardiography and hs-TnT measurement at baseline, with subsequent registry-based recording of events. The primary endpoint was the composite of coronary events, heart failure, stroke, and all-cause mortality. Prognostic properties were evaluated using Kaplan-Meier analyses, Cox regression models, Harrell's C-index, and net reclassification improvement (NRI). Elevated hs-TnT was defined as >= 14 ng/L.
Results: Median age was 66 years (IQR: 60-70) and 486 (70%) were male. Subjects with hs-TnT >= 14 ng/L (n=61, 8.8%) were older, more often male, had higher systolic blood pressures, fasting plasma glucoses, and cystatin C levels, and had a greater prevalence of left ventricular hypertrophy and/or grade 2/3 diastolic dysfunction (LVH/DD; p≤0.002 for all). During a median follow-up of 8.9 (IQR: 8.3-9.7) years, 149 composite events occurred (21.4%). Elevated hs-TnT was a significant predictor of the primary composite endpoint after accounting for age, sex, smoking status, systolic blood pressure, total cholesterol, and cystatin C (HR 1.62 (95% CI: 1.02-2.58), p = 0.04) or LVH/DD (HR 2.50 (95% CI: 1.63-3.83), p<0.001). Elevated hs-TnT added to the discrimination ability of LVH/DD alone (C-index for hsTnT+LVH/DD 0.583 (95% CI: 0.537-0.629) vs. C-index for LVH/DD alone 0.551 (95% CI: 0.509-0.593), p=0.03 for difference) with significant NRI (0.22 (95% CI: 0.04-0.40), p=0.02).
Conclusions: Roughly 10% of clinically stable, apparently healthy older individuals have abnormal hs-TnT values. Elevated hs-TnT identifies patients with abnormal left ventricular size and function and heightened long-term cardiovascular risk in this cohort.
Poster Hall, Hall C
Sunday, March 19, 2017, 9:45 a.m.-10:30 a.m.
Session Title: The Evolving World of LVADs, Transplant and Other Novel Discoveries
Abstract Category: 13. Heart Failure and Cardiomyopathies: Clinical
Presentation Number: 1294-283
- 2017 American College of Cardiology Foundation