Association of Serial Measures of Cardiac Troponin T Using a Sensitive Assay With Incident Heart Failure and Cardiovascular Mortality in Older Adults

deFilippi, Christopher R.; Lemos, James A. de; Christenson, Robert H.; Gottdiener, John S.; Kop, Willem J.; Zhan, Min; Seliger, Stephen L.

doi:10.1001/jama.2010.1708

Cited by 646 publications

(542 citation statements)

References 39 publications

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“…The addition of sST2 to demographics and clinical risk factors only modestly improved discrimination and risk reclassification for incident HF and cardiovascular death. However, similar to other cohorts, increasing levels of ST2 in older adults in a cross‐sectional analysis were associated with higher risk demographics, increased comorbidities, and increasing levels of cardiac specific and noncardiac specific biomarkers that have been independently associated with poorer outcomes 18, 27, 28, 39…”

Section: Discussionsupporting

confidence: 73%

“…Participants (N=5201) initially enrolled in 1989–1990, and an black supplemental cohort (N=687) enrolled in 1992–1993. This ancillary analysis included participants without a previous diagnosis of HF in whom measures of amino terminal pro‐B‐type natriuretic peptide (NT‐proBNP) and high‐sensitivity cardiac troponin T (hs‐cTnT) had already been performed as previously described27, 28 and with available stored serum for measurement of sST2. Figure 1 is a flow diagram of CHS participants who met criteria or were excluded for the present sST2 analysis.…”

Section: Methodsmentioning

confidence: 99%

“…Analyte stability has been demonstrated for at least 1.5 years from previously frozen samples 30. Details of NT‐proBNP, C‐reactive protein (CRP), and hs‐cTnT have been previously described in CHS 27, 28, 31…”

Section: Methodsmentioning

confidence: 99%

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Soluble ST2 for Prediction of Heart Failure and Cardiovascular Death in an Elderly, Community‐Dwelling Population

Parikh

Seliger

Christenson

et al. 2016

JAHA

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BackgroundSoluble ST2 (sST2), a marker of myocyte stretch and fibrosis, has prognostic value in many cardiovascular diseases. We hypothesized that sST2 levels are associated with incident heart failure (HF), including subtypes of preserved (HFpEF) and reduced (HFrEF) ejection fraction, and cardiovascular death.Methods and ResultsBaseline serum sST2 was measured in 3915 older, community‐dwelling subjects from the Cardiovascular Health Study without prevalent HF. sST2 levels were associated with older age, male sex, black race, traditional cardiovascular risk factors, other biomarkers of inflammation, cardiac stretch, myocardial injury, and fibrosis, and abnormal echocardiographic parameters. In longitudinal analysis, greater sST2 was associated with a higher risk of incident HF and cardiovascular death; however, in multivariate models adjusting for other cardiac risk factors and the cardiac‐specific biomarker, N‐terminal pro–type B natriuretic peptide, these associations were attenuated. In these models, an sST2 level above the US Food and Drug Administration–approved cut‐off value (>35 ng/mL) was significantly associated with incident HF (hazard ratio [HR], 1.20; 95% CI, 1.02–1.43) and cardiovascular death (HR, 1.21; 95% CI, 1.02–1.44), and greater sST2 was continuously associated with cardiovascular death (per 1‐ln increment: HR, 1.24; 95% CI, 1.02–1.50). sST2 was not associated with the HF subtypes of HFpEF and HFrEF in adjusted analysis. Addition of sST2 to existing risk models of HF and cardiovascular death modestly improved discrimination and reclassification into a higher risk.ConclusionsThe predictive value of sST2 for HF of all subtypes and cardiovascular death is modest in an elderly population despite strong cross‐sectional associations with risk factors and underlying cardiac pathology.

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Section: Discussionsupporting

confidence: 73%

Section: Methodsmentioning

confidence: 99%

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Soluble ST2 for Prediction of Heart Failure and Cardiovascular Death in an Elderly, Community‐Dwelling Population

Parikh

Seliger

Christenson

et al. 2016

JAHA

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“…The present findings demonstrating additive prognostic information of repeat measurement for the risk of cardiovascular mortality in patients with AF are in accordance with findings in previous studies with other patient populations, eg, those with coronary artery disease and heart failure and in apparently healthy adults, in which serial measurements of cTn have been shown to be powerful markers of mortality and morbidity 15, 22, 23, 24. Our findings in the present study therefore extend these observations to a novel population and validate previous results by displaying the prognostic importance of a repeated measurement of cTn in patients with AF related to mortality risk.…”

Section: Discussionsupporting

confidence: 93%

Repeated Measurements of Cardiac Biomarkers in Atrial Fibrillation and Validation of the ABC Stroke Score Over Time

Hijazi

Lindahl

Oldgren

et al. 2017

JAHA

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BackgroundCardiac biomarkers are independent risk markers in atrial fibrillation, and the novel biomarker–based ABC stroke score (age, biomarkers, and clinical history of prior stroke) was recently shown to improve the prediction of stroke risk in patients with atrial fibrillation. Our aim was to investigate the short‐term variability of the cardiac biomarkers and evaluate whether the ABC stroke risk score provides a stable short‐term risk estimate.Methods and ResultsAccording to the study protocol, samples were obtained at entry and also at 2 months in 4796 patients with atrial fibrillation followed for a median of 1.8 years in the ARISTOTLE (Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation) trial. Cardiac troponin I, cardiac troponin T, and N‐terminal pro‐B‐type natriuretic peptide were measured with high‐sensitivity immunoassays. Associations with outcomes were evaluated by Cox regression. C indices and calibration plots were used to evaluate the ABC stroke score at 2 months. The average changes in biomarker levels during 2 months were small (median change cardiac troponin T +2.8%, troponin I +2.0%, and N‐terminal pro‐B‐type natriuretic peptide +13.5%) and within‐subject correlation was high (all ≥0.82). Repeated measurement of cardiac biomarkers provided some incremental prognostic value for mortality but not for stroke when combined with clinical risk factors and baseline levels of the biomarkers. Based on 8702 person‐years of follow‐up and 96 stroke/systemic embolic events, the ABC stroke score at 2 months achieved a similar C index of 0.70 (95% CI, 0.65–0.76) as compared with 0.70 (95% CI, 0.65–0.75) at baseline. The ABC stroke score remained well calibrated using predefined risk classes.ConclusionsIn patients with stable atrial fibrillation, the variability of the cardiac biomarkers and the biomarker‐based ABC stroke score during 2 months are small. The prognostic information by the ABC stroke score remains consistent and well calibrated with similar good predictive performance if patients are retested after 2 months.Clinical Trial RegistrationURL: http://www.clinicaltrials.gov. Unique identifier: NCT00412984.

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“…Cardiac troponin T, alone or in combination with N‐terminal fragment of the prohormone of B‐type natriuretic peptide (NT‐proBNP), and products of collagen metabolism have been evaluated for identification of hypertensive patients at risk for HF 84, 85, 86, 87…”

Section: Aging Phenotypementioning

confidence: 99%

Clinical Phenotypes in Heart Failure With Preserved Ejection Fraction

Samson

Jaiswal

Ennezat

et al. 2016

JAHA

110

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Association of Serial Measures of Cardiac Troponin T Using a Sensitive Assay With Incident Heart Failure and Cardiovascular Mortality in Older Adults

Cited by 646 publications

References 39 publications

Soluble ST2 for Prediction of Heart Failure and Cardiovascular Death in an Elderly, Community‐Dwelling Population

Soluble ST2 for Prediction of Heart Failure and Cardiovascular Death in an Elderly, Community‐Dwelling Population

Repeated Measurements of Cardiac Biomarkers in Atrial Fibrillation and Validation of the ABC Stroke Score Over Time

Clinical Phenotypes in Heart Failure With Preserved Ejection Fraction

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