Long-Term Trajectory of Two Unique Cardiac Biomarkers and Subsequent Left Ventricular Structural Pathology and Risk of Incident Heart Failure in Community-Dwelling Older Adults at Low Baseline Risk

Study Questions:

Are the combined trajectories of high-sensitivity cardiac troponin T (hs-cTnT) and N-terminal pro-brain natriuretic peptide (NT-proBNP) predictive of structural heart disease, incident heart failure (HF), or death in older adults initially free of HF?

Methods:

This was an analysis of older adults initially free of cardiovascular disease (CVD) in the Cardiovascular Health Study (CHS). Participants (n = 5,201) were initially enrolled in 1989 and 1990, and an African-American supplemental cohort was enrolled in 1992 and 1993. NT-proBNP and hs-cTnT were measured at baseline and after 2-3 years. Outcomes were incident HF and CV mortality.

Results:

Participants from 2008 were included in the analysis. Approximately one third of the study population had an increase in at least one biomarker between blood draws. The relative risk adjusted for demographic and HF risk factors comparing those with increasing in both biomarkers versus neither biomarker was 3.56 for incident HF (95% confidence interval [CI], 2.56-4.97) and 2.98 for CV mortality (95% CI, 2.98-4.26). Among 1,340 patients who had a normal left ventricular ejection fraction (LVEF) at baseline, the frequency of new abnormal LVEF was 11.8% versus 4% for those with increases in both hs-cTnT and NT-proBNP versus those without an increase in either biomarker (p = 0.007).

Conclusions:

The combined trajectories of hs-cTnT and NT-proBNP over 2-3 years are predictive of asymptomatic systolic dysfunction, incident HF, and CV mortality among older adults initially without HF and with low levels of these biomarkers.

Perspective:

Previous analyses have demonstrated that the trajectory of change of a single cardiac-specific biomarker may be predictive of CV risk. The present study adds to these studies by demonstrating that the combined trajectories of hs-cTnT and NT-proBNP are additive in predicting CVD in older adults initially without any overt evidence of such disease.

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

Keywords: Troponin T, Risk Factors, Natriuretic Peptides, Biological Markers, Troponin I, Heart Failure, Cardiovascular Diseases, Stroke Volume, Ventricular Function, Confidence Intervals, Heart Ventricles, United States


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