Prognostic value of high-sensitivity troponin T in chronic heart failure an individual patient data meta-analysis

Alberto Aimo, James L. Januzzi, Giuseppe G.V. Vergaro, Andrea Ripoli, Roberto Latini, Serge Masson, Michela Magnoli, Inder S. Anand, Jay N. Cohn, Luigi Tavazzi, Gianni Tognoni, Jørgen Gravning, Thor Ueland, Ståle H. Nymo, Hans Peter Brunner-La Rocca, Antoni Bayes Genis, Josep Lupón, Rudolf A. De Boer, Akiomi Yoshihisa, Yasuchika Takeishi & 10 others Michael Egstrup, Ida Gustafsson, Hanna K. Gaggin, Kai M. Eggers, Kurt Huber, Ioannis Tentzeris, Wai H.W. Tang, Justin Grodin, Claudio Passino, Michele Emdin

Research output: Contribution to journalReview article

22 Citations (Scopus)

Abstract

Background: Most patients with chronic heart failure have detectable troponin concentrations when evaluated by high-sensitivity assays. The prognostic relevance of this fnding has not been clearly established so far. We aimed to assess high-sensitivity troponin assay for risk stratifcation in chronic heart failure through a meta-analysis approach. METHODS: Medline, EMBASE, Cochrane Library, and Scopus were searched in April 2017 by 2 independent authors. The terms were "troponin" AND "heart failure" OR "cardiac failure" OR "cardiac dysfunction" OR "cardiac insuffciency" OR "left ventricular dysfunction." Inclusion criteria were English language, clinical stability, use of a high-sensitivity troponin assay, follow-up studies, and availability of individual patient data after request to authors. Data retrieved from articles and provided by authors were used in agreement with the PRISMA statement. The end points were all-cause death, cardiovascular death, and hospitalization for cardiovascular cause. RESULTS: Ten studies were included, reporting data on 11 cohorts and 9289 patients (age 66±12 years, 77% men, 60% ischemic heart failure, 85% with left ventricular ejection fraction <40%). High-sensitivity troponin T data were available for all patients, whereas only 209 patients also had high-sensitivity troponin I assayed. When added to a prognostic model including established risk markers (sex, age, ischemic versus nonischemic etiology, left ventricular ejection fraction, estimated glomerular fltration rate, and N-terminal fraction of pro-B-type natriuretic peptide), high-sensitivity troponin T remained independently associated with all-cause mortality (hazard ratio, 1.48; 95% confdence interval, 1.41-1.55), cardiovascular mortality (hazard ratio, 1.40 95% confdence interval, 1.33-1.48), and cardiovascular hospitalization (hazard ratio, 1.42 95% confdence interval, 1.36-1.49), over a median 2.4-year follow-up (all P<0.001). High-sensitivity troponin T signifcantly improved risk prediction when added to a prognostic model including the variables above. It also displayed an independent prognostic value for all outcomes in almost all population subgroups. The area under the curve-derived 18 ng/L cutoff yielded independent prognostic value for the 3 end points in both men and women, patients with either ischemic or nonischemic etiology, and across categories of renal dysfunction. CONCLUSIONS: In chronic heart failure, high-sensitivity troponin T is a strong and independent predictor of all-cause and cardiovascular mortality, and of hospitalization for cardiovascular causes, as well. This biomarker then represents an additional tool for prognostic stratifcation.

Original languageEnglish (US)
Pages (from-to)286-297
Number of pages12
JournalCirculation
Volume137
Issue number3
DOIs
StatePublished - Jan 1 2018

Fingerprint

Troponin T
Meta-Analysis
Troponin
Heart Failure
Hospitalization
Stroke Volume
Mortality
Troponin I
Brain Natriuretic Peptide
Left Ventricular Dysfunction
Libraries
Area Under Curve
Cause of Death
Research Design
Language
Biomarkers
Kidney
Population

Keywords

  • Heart failure
  • Metaanalysis
  • Prognosis
  • Troponin T
  • Ventricular dysfunction, left

PubMed: MeSH publication types

  • Journal Article
  • Meta-Analysis
  • Systematic Review

Cite this

Aimo, A., Januzzi, J. L., Vergaro, G. G. V., Ripoli, A., Latini, R., Masson, S., ... Emdin, M. (2018). Prognostic value of high-sensitivity troponin T in chronic heart failure an individual patient data meta-analysis. Circulation, 137(3), 286-297. https://doi.org/10.1161/CIRCULATIONAHA.117.031560

Prognostic value of high-sensitivity troponin T in chronic heart failure an individual patient data meta-analysis. / Aimo, Alberto; Januzzi, James L.; Vergaro, Giuseppe G.V.; Ripoli, Andrea; Latini, Roberto; Masson, Serge; Magnoli, Michela; Anand, Inder S.; Cohn, Jay N.; Tavazzi, Luigi; Tognoni, Gianni; Gravning, Jørgen; Ueland, Thor; Nymo, Ståle H.; Brunner-La Rocca, Hans Peter; Genis, Antoni Bayes; Lupón, Josep; De Boer, Rudolf A.; Yoshihisa, Akiomi; Takeishi, Yasuchika; Egstrup, Michael; Gustafsson, Ida; Gaggin, Hanna K.; Eggers, Kai M.; Huber, Kurt; Tentzeris, Ioannis; Tang, Wai H.W.; Grodin, Justin; Passino, Claudio; Emdin, Michele.

In: Circulation, Vol. 137, No. 3, 01.01.2018, p. 286-297.

Research output: Contribution to journalReview article

Aimo, A, Januzzi, JL, Vergaro, GGV, Ripoli, A, Latini, R, Masson, S, Magnoli, M, Anand, IS, Cohn, JN, Tavazzi, L, Tognoni, G, Gravning, J, Ueland, T, Nymo, SH, Brunner-La Rocca, HP, Genis, AB, Lupón, J, De Boer, RA, Yoshihisa, A, Takeishi, Y, Egstrup, M, Gustafsson, I, Gaggin, HK, Eggers, KM, Huber, K, Tentzeris, I, Tang, WHW, Grodin, J, Passino, C & Emdin, M 2018, 'Prognostic value of high-sensitivity troponin T in chronic heart failure an individual patient data meta-analysis' Circulation, vol. 137, no. 3, pp. 286-297. https://doi.org/10.1161/CIRCULATIONAHA.117.031560
Aimo, Alberto ; Januzzi, James L. ; Vergaro, Giuseppe G.V. ; Ripoli, Andrea ; Latini, Roberto ; Masson, Serge ; Magnoli, Michela ; Anand, Inder S. ; Cohn, Jay N. ; Tavazzi, Luigi ; Tognoni, Gianni ; Gravning, Jørgen ; Ueland, Thor ; Nymo, Ståle H. ; Brunner-La Rocca, Hans Peter ; Genis, Antoni Bayes ; Lupón, Josep ; De Boer, Rudolf A. ; Yoshihisa, Akiomi ; Takeishi, Yasuchika ; Egstrup, Michael ; Gustafsson, Ida ; Gaggin, Hanna K. ; Eggers, Kai M. ; Huber, Kurt ; Tentzeris, Ioannis ; Tang, Wai H.W. ; Grodin, Justin ; Passino, Claudio ; Emdin, Michele. / Prognostic value of high-sensitivity troponin T in chronic heart failure an individual patient data meta-analysis. In: Circulation. 2018 ; Vol. 137, No. 3. pp. 286-297.
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TY - JOUR

T1 - Prognostic value of high-sensitivity troponin T in chronic heart failure an individual patient data meta-analysis

AU - Aimo, Alberto

AU - Januzzi, James L.

AU - Vergaro, Giuseppe G.V.

AU - Ripoli, Andrea

AU - Latini, Roberto

AU - Masson, Serge

AU - Magnoli, Michela

AU - Anand, Inder S.

AU - Cohn, Jay N.

AU - Tavazzi, Luigi

AU - Tognoni, Gianni

AU - Gravning, Jørgen

AU - Ueland, Thor

AU - Nymo, Ståle H.

AU - Brunner-La Rocca, Hans Peter

AU - Genis, Antoni Bayes

AU - Lupón, Josep

AU - De Boer, Rudolf A.

AU - Yoshihisa, Akiomi

AU - Takeishi, Yasuchika

AU - Egstrup, Michael

AU - Gustafsson, Ida

AU - Gaggin, Hanna K.

AU - Eggers, Kai M.

AU - Huber, Kurt

AU - Tentzeris, Ioannis

AU - Tang, Wai H.W.

AU - Grodin, Justin

AU - Passino, Claudio

AU - Emdin, Michele

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Background: Most patients with chronic heart failure have detectable troponin concentrations when evaluated by high-sensitivity assays. The prognostic relevance of this fnding has not been clearly established so far. We aimed to assess high-sensitivity troponin assay for risk stratifcation in chronic heart failure through a meta-analysis approach. METHODS: Medline, EMBASE, Cochrane Library, and Scopus were searched in April 2017 by 2 independent authors. The terms were "troponin" AND "heart failure" OR "cardiac failure" OR "cardiac dysfunction" OR "cardiac insuffciency" OR "left ventricular dysfunction." Inclusion criteria were English language, clinical stability, use of a high-sensitivity troponin assay, follow-up studies, and availability of individual patient data after request to authors. Data retrieved from articles and provided by authors were used in agreement with the PRISMA statement. The end points were all-cause death, cardiovascular death, and hospitalization for cardiovascular cause. RESULTS: Ten studies were included, reporting data on 11 cohorts and 9289 patients (age 66±12 years, 77% men, 60% ischemic heart failure, 85% with left ventricular ejection fraction <40%). High-sensitivity troponin T data were available for all patients, whereas only 209 patients also had high-sensitivity troponin I assayed. When added to a prognostic model including established risk markers (sex, age, ischemic versus nonischemic etiology, left ventricular ejection fraction, estimated glomerular fltration rate, and N-terminal fraction of pro-B-type natriuretic peptide), high-sensitivity troponin T remained independently associated with all-cause mortality (hazard ratio, 1.48; 95% confdence interval, 1.41-1.55), cardiovascular mortality (hazard ratio, 1.40 95% confdence interval, 1.33-1.48), and cardiovascular hospitalization (hazard ratio, 1.42 95% confdence interval, 1.36-1.49), over a median 2.4-year follow-up (all P<0.001). High-sensitivity troponin T signifcantly improved risk prediction when added to a prognostic model including the variables above. It also displayed an independent prognostic value for all outcomes in almost all population subgroups. The area under the curve-derived 18 ng/L cutoff yielded independent prognostic value for the 3 end points in both men and women, patients with either ischemic or nonischemic etiology, and across categories of renal dysfunction. CONCLUSIONS: In chronic heart failure, high-sensitivity troponin T is a strong and independent predictor of all-cause and cardiovascular mortality, and of hospitalization for cardiovascular causes, as well. This biomarker then represents an additional tool for prognostic stratifcation.

AB - Background: Most patients with chronic heart failure have detectable troponin concentrations when evaluated by high-sensitivity assays. The prognostic relevance of this fnding has not been clearly established so far. We aimed to assess high-sensitivity troponin assay for risk stratifcation in chronic heart failure through a meta-analysis approach. METHODS: Medline, EMBASE, Cochrane Library, and Scopus were searched in April 2017 by 2 independent authors. The terms were "troponin" AND "heart failure" OR "cardiac failure" OR "cardiac dysfunction" OR "cardiac insuffciency" OR "left ventricular dysfunction." Inclusion criteria were English language, clinical stability, use of a high-sensitivity troponin assay, follow-up studies, and availability of individual patient data after request to authors. Data retrieved from articles and provided by authors were used in agreement with the PRISMA statement. The end points were all-cause death, cardiovascular death, and hospitalization for cardiovascular cause. RESULTS: Ten studies were included, reporting data on 11 cohorts and 9289 patients (age 66±12 years, 77% men, 60% ischemic heart failure, 85% with left ventricular ejection fraction <40%). High-sensitivity troponin T data were available for all patients, whereas only 209 patients also had high-sensitivity troponin I assayed. When added to a prognostic model including established risk markers (sex, age, ischemic versus nonischemic etiology, left ventricular ejection fraction, estimated glomerular fltration rate, and N-terminal fraction of pro-B-type natriuretic peptide), high-sensitivity troponin T remained independently associated with all-cause mortality (hazard ratio, 1.48; 95% confdence interval, 1.41-1.55), cardiovascular mortality (hazard ratio, 1.40 95% confdence interval, 1.33-1.48), and cardiovascular hospitalization (hazard ratio, 1.42 95% confdence interval, 1.36-1.49), over a median 2.4-year follow-up (all P<0.001). High-sensitivity troponin T signifcantly improved risk prediction when added to a prognostic model including the variables above. It also displayed an independent prognostic value for all outcomes in almost all population subgroups. The area under the curve-derived 18 ng/L cutoff yielded independent prognostic value for the 3 end points in both men and women, patients with either ischemic or nonischemic etiology, and across categories of renal dysfunction. CONCLUSIONS: In chronic heart failure, high-sensitivity troponin T is a strong and independent predictor of all-cause and cardiovascular mortality, and of hospitalization for cardiovascular causes, as well. This biomarker then represents an additional tool for prognostic stratifcation.

KW - Heart failure

KW - Metaanalysis

KW - Prognosis

KW - Troponin T

KW - Ventricular dysfunction, left

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