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?


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.


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).


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.


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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