Prognostic value of very low plasma concentrations of troponin T in patients with stable chronic heart failure

Roberto Latini, Serge Masson, Inder S. Anand, Emil Missov, Marjorie Carlson, Tarcisio Vago, Laura Angelici, Simona Barlera, Giovanni Parrinello, Aldo P. Maggioni, Gianni Tognoni, Jay N. Cohn

Research output: Contribution to journalArticle

532 Citations (Scopus)

Abstract

BACKGROUND - Circulating cardiac troponin T, a marker of cardiomyocyte injury, predicts adverse outcome in patients with heart failure (HF) but is detectable in only a small fraction of those with chronic stable HF. We assessed the prognostic value of circulating cardiac troponin T in patients with stable chronic HF with a traditional (cTnT) and a new precommercial highly sensitive assay (hsTnT). METHODS AND RESULTS - Plasma troponin T was measured in 4053 patients with chronic HF enrolled in the Valsartan Heart Failure Trial (Val-HeFT). Troponin T was detectable in 10.4% of the population with the cTnT assay (detection limit ≤0.01 ng/mL) compared with 92.0% with the new hsTnT assay (≤0.001 ng/mL). Patients with cTnT elevation or with hsTnT above the median (0.012 ng/mL) had more severe HF and worse outcome. In Cox proportional hazards models adjusting for clinical risk factors, cTnT was associated with death (780 events; hazard ratio=2.08; 95% confidence interval, 1.72 to 2.52; P<0.0001) and first hospitalization for HF (655 events; hazard ratio=1.55; 95% confidence interval, 1.25 to 1.93; P<0.0001). HsTnT was associated with the risk of death in unadjusted analysis for deciles of concentrations and in multivariable models (hazard ratio=1.05; 95% confidence interval, 1.04 to 1.07 for increments of 0.01 ng/mL; P<0.0001). Addition of hsTnT to well-calibrated models adjusted for clinical risk factors, with or without brain natriuretic peptide, significantly improved prognostic discrimination (C-index, P<0.0001 for both outcomes). CONCLUSIONS - In this large population of patients with HF, detectable cTnT predicts adverse outcomes in chronic HF. By the highly sensitive assay, troponin T retains a prognostic value at previously undetectable concentrations.

Original languageEnglish (US)
Pages (from-to)1242-1249
Number of pages8
JournalCirculation
Volume116
Issue number11
DOIs
StatePublished - Sep 1 2007

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Troponin T
Heart Failure
Valsartan
Confidence Intervals
Proportional Hazards Models
Brain Natriuretic Peptide
Cardiac Myocytes
Population
Limit of Detection
Hospitalization

Keywords

  • Heart failure
  • Natriuretic peptides
  • Prognosis
  • Troponin

Cite this

Prognostic value of very low plasma concentrations of troponin T in patients with stable chronic heart failure. / Latini, Roberto; Masson, Serge; Anand, Inder S.; Missov, Emil; Carlson, Marjorie; Vago, Tarcisio; Angelici, Laura; Barlera, Simona; Parrinello, Giovanni; Maggioni, Aldo P.; Tognoni, Gianni; Cohn, Jay N.

In: Circulation, Vol. 116, No. 11, 01.09.2007, p. 1242-1249.

Research output: Contribution to journalArticle

Latini, R, Masson, S, Anand, IS, Missov, E, Carlson, M, Vago, T, Angelici, L, Barlera, S, Parrinello, G, Maggioni, AP, Tognoni, G & Cohn, JN 2007, 'Prognostic value of very low plasma concentrations of troponin T in patients with stable chronic heart failure', Circulation, vol. 116, no. 11, pp. 1242-1249. https://doi.org/10.1161/CIRCULATIONAHA.106.655076
Latini, Roberto ; Masson, Serge ; Anand, Inder S. ; Missov, Emil ; Carlson, Marjorie ; Vago, Tarcisio ; Angelici, Laura ; Barlera, Simona ; Parrinello, Giovanni ; Maggioni, Aldo P. ; Tognoni, Gianni ; Cohn, Jay N. / Prognostic value of very low plasma concentrations of troponin T in patients with stable chronic heart failure. In: Circulation. 2007 ; Vol. 116, No. 11. pp. 1242-1249.
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abstract = "BACKGROUND - Circulating cardiac troponin T, a marker of cardiomyocyte injury, predicts adverse outcome in patients with heart failure (HF) but is detectable in only a small fraction of those with chronic stable HF. We assessed the prognostic value of circulating cardiac troponin T in patients with stable chronic HF with a traditional (cTnT) and a new precommercial highly sensitive assay (hsTnT). METHODS AND RESULTS - Plasma troponin T was measured in 4053 patients with chronic HF enrolled in the Valsartan Heart Failure Trial (Val-HeFT). Troponin T was detectable in 10.4{\%} of the population with the cTnT assay (detection limit ≤0.01 ng/mL) compared with 92.0{\%} with the new hsTnT assay (≤0.001 ng/mL). Patients with cTnT elevation or with hsTnT above the median (0.012 ng/mL) had more severe HF and worse outcome. In Cox proportional hazards models adjusting for clinical risk factors, cTnT was associated with death (780 events; hazard ratio=2.08; 95{\%} confidence interval, 1.72 to 2.52; P<0.0001) and first hospitalization for HF (655 events; hazard ratio=1.55; 95{\%} confidence interval, 1.25 to 1.93; P<0.0001). HsTnT was associated with the risk of death in unadjusted analysis for deciles of concentrations and in multivariable models (hazard ratio=1.05; 95{\%} confidence interval, 1.04 to 1.07 for increments of 0.01 ng/mL; P<0.0001). Addition of hsTnT to well-calibrated models adjusted for clinical risk factors, with or without brain natriuretic peptide, significantly improved prognostic discrimination (C-index, P<0.0001 for both outcomes). CONCLUSIONS - In this large population of patients with HF, detectable cTnT predicts adverse outcomes in chronic HF. By the highly sensitive assay, troponin T retains a prognostic value at previously undetectable concentrations.",
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AU - Latini, Roberto

AU - Masson, Serge

AU - Anand, Inder S.

AU - Missov, Emil

AU - Carlson, Marjorie

AU - Vago, Tarcisio

AU - Angelici, Laura

AU - Barlera, Simona

AU - Parrinello, Giovanni

AU - Maggioni, Aldo P.

AU - Tognoni, Gianni

AU - Cohn, Jay N.

PY - 2007/9/1

Y1 - 2007/9/1

N2 - BACKGROUND - Circulating cardiac troponin T, a marker of cardiomyocyte injury, predicts adverse outcome in patients with heart failure (HF) but is detectable in only a small fraction of those with chronic stable HF. We assessed the prognostic value of circulating cardiac troponin T in patients with stable chronic HF with a traditional (cTnT) and a new precommercial highly sensitive assay (hsTnT). METHODS AND RESULTS - Plasma troponin T was measured in 4053 patients with chronic HF enrolled in the Valsartan Heart Failure Trial (Val-HeFT). Troponin T was detectable in 10.4% of the population with the cTnT assay (detection limit ≤0.01 ng/mL) compared with 92.0% with the new hsTnT assay (≤0.001 ng/mL). Patients with cTnT elevation or with hsTnT above the median (0.012 ng/mL) had more severe HF and worse outcome. In Cox proportional hazards models adjusting for clinical risk factors, cTnT was associated with death (780 events; hazard ratio=2.08; 95% confidence interval, 1.72 to 2.52; P<0.0001) and first hospitalization for HF (655 events; hazard ratio=1.55; 95% confidence interval, 1.25 to 1.93; P<0.0001). HsTnT was associated with the risk of death in unadjusted analysis for deciles of concentrations and in multivariable models (hazard ratio=1.05; 95% confidence interval, 1.04 to 1.07 for increments of 0.01 ng/mL; P<0.0001). Addition of hsTnT to well-calibrated models adjusted for clinical risk factors, with or without brain natriuretic peptide, significantly improved prognostic discrimination (C-index, P<0.0001 for both outcomes). CONCLUSIONS - In this large population of patients with HF, detectable cTnT predicts adverse outcomes in chronic HF. By the highly sensitive assay, troponin T retains a prognostic value at previously undetectable concentrations.

AB - BACKGROUND - Circulating cardiac troponin T, a marker of cardiomyocyte injury, predicts adverse outcome in patients with heart failure (HF) but is detectable in only a small fraction of those with chronic stable HF. We assessed the prognostic value of circulating cardiac troponin T in patients with stable chronic HF with a traditional (cTnT) and a new precommercial highly sensitive assay (hsTnT). METHODS AND RESULTS - Plasma troponin T was measured in 4053 patients with chronic HF enrolled in the Valsartan Heart Failure Trial (Val-HeFT). Troponin T was detectable in 10.4% of the population with the cTnT assay (detection limit ≤0.01 ng/mL) compared with 92.0% with the new hsTnT assay (≤0.001 ng/mL). Patients with cTnT elevation or with hsTnT above the median (0.012 ng/mL) had more severe HF and worse outcome. In Cox proportional hazards models adjusting for clinical risk factors, cTnT was associated with death (780 events; hazard ratio=2.08; 95% confidence interval, 1.72 to 2.52; P<0.0001) and first hospitalization for HF (655 events; hazard ratio=1.55; 95% confidence interval, 1.25 to 1.93; P<0.0001). HsTnT was associated with the risk of death in unadjusted analysis for deciles of concentrations and in multivariable models (hazard ratio=1.05; 95% confidence interval, 1.04 to 1.07 for increments of 0.01 ng/mL; P<0.0001). Addition of hsTnT to well-calibrated models adjusted for clinical risk factors, with or without brain natriuretic peptide, significantly improved prognostic discrimination (C-index, P<0.0001 for both outcomes). CONCLUSIONS - In this large population of patients with HF, detectable cTnT predicts adverse outcomes in chronic HF. By the highly sensitive assay, troponin T retains a prognostic value at previously undetectable concentrations.

KW - Heart failure

KW - Natriuretic peptides

KW - Prognosis

KW - Troponin

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