Author + information
- Received September 10, 2019
- Revision received December 17, 2019
- Accepted December 17, 2019
- Published online April 27, 2020.
- Isabell Yan, MDa,∗,
- Christin S. Börschel, MDa,b,∗,
- Johannes T. Neumann, MDa,b,
- Ngoc A. Sprünkera,
- Nataliya Makarovaa,b,
- Jukka Konttoc,
- Kari Kuulasmaa, PhDc,
- Veikko Salomaa, MD, PhDc,
- Christina Magnussen, MDa,b,
- Licia Iacoviello, MD, PhDd,e,
- Augusto Di Castelnuovo, PhD, MScf,
- Simona Costanzo, PhD, MScd,
- Allan Linneberg, MD, PhDg,h,
- Stefan Söderberg, MD, PhDi,
- Tanja Zeller, PhDa,b,
- Francisco M. Ojeda-Echevarria, PhDa,
- Stefan Blankenberg, MDa,b and
- Dirk Westermann, MDa,b,∗ ()
- aDepartment of Cardiology, University Heart and Vascular Centre Hamburg, Hamburg, Germany
- bGerman Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck, Hamburg, Germany
- cNational Institute for Health and Welfare, Helsinki, Finland
- dDepartment of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Italy
- eResearch Center in Epidemiology and Preventive Medicine, Department of Medicine and Surgery, University of Insubria, Varese, Italy
- fMediterranea Cardiocentro, Napoli, Italy
- gDepartment of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- hCenter for Clinical Research and Disease Prevention, Bispebjerg and Frederiksberg Hospital, The Capital Region, Copenhagen, Denmark
- iDepartment of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
- ↵∗Address for correspondence:
Dr. Dirk Westermann, University Heart and Vascular Center Hamburg, Department of Cardiology, Martinistrasse 52, 20246 Hamburg, Germany.
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.
- cardiovascular risk factors
- high-sensitivity cardiac troponin I
- N-terminal pro-B-type natriuretic peptide
- prediction of heart failure
↵∗ Drs. Yan and Börschel contributed equally to this work.
The BiomarCaRE Project is funded by the European Union Seventh Framework Programme (FP7/2007-2013) under grant agreement no. HEALTH-F2-2011-278913. The activities of the MORGAM Data Centre have been sustained by recent funding from European Union FP 7 project CHANCES (HEALTH-F3-2010-242244). A part of the biomarker determinations in the population cohorts was funded by the Medical Research Council London (G0601463, identification no. 80983: Biomarkers in the MORGAM Populations). The DanMONICA cohorts at the Research Centre for Prevention and Health were established over a period of 10 years and have been funded by numerous sources. The FINRISK surveys were mainly funded by budgetary funds of the National Institute for Health and Welfare, Helsinki, Finland. Additional funding has been obtained from numerous nonprofit foundations. The Moli-sani project was partially supported by research grants from Pfizer Foundation (Rome, Italy), the Italian Ministry of University and Research (MIUR, Rome, Italy)–Programma Triennale di Ricerca, Decreto n.1588, and Instrumentation Laboratory, Milan, Italy. The Northern Sweden MONICA study was supported by Norrbotten and Västerbotten County Councils, the Swedish Research Council (2011_2395), the Swedish Research Council for Health, Working Life and Welfare, the Swedish Heart and Lung Foundation (20140799, 20120631, 20100635), and the Joint Committee of the County Councils in Northern Sweden. Dr. Blankenberg has received grants and personal fees from Abbott Diagnostics, Bayer, SIEMENS, and Thermo Fisher; grants from Singulex; and has received personal fees from AstraZeneca, AMGEN, Medtronic, Pfizer, Roche, Novartis, and SIEMENS Diagnostics outside the submitted work. Dr. Neumann has received personal fees from Abbott and Siemens; and has received grants from the German Heart Foundation/German Foundation of Heart Research and the Else Kröner Fresenius Stiftung outside the submitted work. Dr. Salomaa has received personal fees from Novo Nordisk; and has received grants from Bayer Ltd. outside the submitted work. Dr. Söderberg has participated in advisory boards for Actelion Ltd.; and has received speaker honoraria from Actelion Ltd. and Bayer Ltd. (unrelated to the present study). Dr. Kuulasmaa has received grants from the European Union and the Medical Research Council, during the conduct of the study. Dr. Westermann has received personal fees from Bayer, Boehringer Ingelheim, Berlin Chemie, AstraZeneca, Biotronik, and Novartis outside the submitted work. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Heart Failure author instructions page.
- Received September 10, 2019.
- Revision received December 17, 2019.
- Accepted December 17, 2019.
- 2020 The Authors