Increased Cardiac Troponin I as Measured by a High-Sensitivity Assay Is Associated With High Odds of Cardiovascular Death: The Minnesota Heart Survey

Study Questions:

What markers are useful for predicting cardiovascular (CV) mortality in the asymptomatic outpatient?

Methods:

The authors examined several biomarkers of different pathophysiologic pathways as predictors of cardiovascular mortality in participants enrolled in the Minnesota Heart Survey (MHS), a population-based study of CV disease (CVD) risk factors. In a nested case-control study, seven biomarkers were assayed in serum samples from 211 patients identified after 8-15 years of follow-up who died of CV causes (CV heart disease, stroke, congestive heart failure) and 253 controls matched on age, sex, and study year. Markers included high-sensitivity cardiac troponin I (hs-cTnI) (Erenna System [Singulex], 99th percentile value of 10.2 ng/L), sensitive cTnI (VITROS Troponin I ES assay [Ortho-Clinical Diagnostics], 99th percentile value of 34 ng/L), copeptin, N-terminal pro-B-type natriuretic peptide (NT-proBNP), high-sensitivity C-reactive protein (hs-CRP), midregional pro-A-type natriuretic peptide (MRproANP), and ST2. Logistic regression analysis was used to evaluate the relations of biomarkers relative to the odds of CVD mortality.

Results:

Cases survived a median of 7.2 years after enrollment. Increased NT-proBNP (19% vs. 4.3%), increased hs-CRP (71% vs. 51%), and increased hs-cTnI (8.7% vs. 1.0%) were more common among cases than among controls (all p < 0.001 in unadjusted analyses). Cases versus controls were more likely to have increased hs-cTnI (9% vs. 1%) compared to the traditional cTnI (3% vs. 1%). The adjusted odds of death were greater among cases compared to controls for increased NT-proBNP (odds ratio [OR], 5.77; 95% confidence interval [CI], 2.2-15), hs-CRP (OR, 1.7; 95% CI, 1.03-2.9), and hs-cTnI (OR, 8.5; 95% CI, 1.7-43), and decreased ST2 (OR, 1.9; 95% CI, 1.05-3.5).

Conclusions:

The authors concluded that the hs-cTnI assay is an important biomarker associated with increased CV death in a community sample when evaluated in a multiple biomarker analysis.

Perspective:

This study provides additional information augmenting the previous data with hs-cTnT suggesting the importance of hs-cTnI in primary prevention. Few patients (9%) had values above the 99th% upper reference limit, suggesting that with the development of structural heart disease, that hs-cTnI values, just like hs-cTnT values, rise and provide a diagnostic signal of the presence of such disease.

Clinical Topics: Heart Failure and Cardiomyopathies, Prevention, Acute Heart Failure, Heart Failure and Cardiac Biomarkers

Keywords: Heart Diseases, Stroke, Follow-Up Studies, Case-Control Studies, Biological Markers, Minnesota, Troponin I, Heart Failure, Cardiovascular Diseases, Risk Factors, Myocardium, Primary Prevention


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