TY - JOUR
T1 - Troponin T and N-Terminal Pro-B-type natriuretic peptide
T2 - A biomarker approach to predict heart failure risk-the atherosclerosis risk in communities study
AU - Nambi, Vijay
AU - Liu, Xiaoxi
AU - Chambless, Lloyd E.
AU - De Lemos, James A.
AU - Virani, Salim S.
AU - Agarwal, Sunil
AU - Boerwinkle, Eric
AU - Hoogeveen, Ron C.
AU - Aguilar, David
AU - Astor, Brad C.
AU - Srinivas, Pothur R.
AU - Deswal, Anita
AU - Mosley, Thomas H.
AU - Coresh, Josef
AU - Folsom, Aaron R.
AU - Heiss, Gerardo
AU - Ballantyne, Christie M.
PY - 2013/12
Y1 - 2013/12
N2 - BACKGROUND: Among the various cardiovascular diseases, heart failure (HF) is projected to have the largest increases in incidence over the coming decades; therefore, improving HF prediction is of significant value. Weevaluated whether cardiac troponin T (cTnT) measured with a high-sensitivity assay and N-terminal pro-B-type natriuretic peptide (NT-proBNP), biomarkers strongly associated with incident HF, improve HF risk prediction in the Atherosclerosis Risk in Communities (ARIC) study. METHODS: Using sex-specific models, we added cTnT and NT-proBNP to age and race ("laboratory report" model) and to the ARIC HF model (includes age, race, systolic blood pressure, antihypertensive medication use, current/former smoking, diabetes, body mass index, prevalent coronary heart disease, and heart rate) in 9868 participants without prevalent HF; area under the receiver operating characteristic curve (AUC), integrated discrimination improvement, net reclassification improvement (NRI), and model fit were described. RESULTS: Over a mean follow-up of 10.4 years, 970 participants developed incident HF. Adding cTnT and NT-proBNP to the ARIC HF model significantly improved all statistical parameters (AUCs increased by 0.040 and 0.057; the continuous NRIs were 50.7% and 54.7% in women and men, respectively). Interestingly, the simpler laboratory report model was statistically no different than the ARIC HF model. CONCLUSIONS: cTnT and NT-proBNP have significant value in HF risk prediction. A simple sex-specific model that includes age, race, cTnT, and NT-proBNP (which can be incorporated in a laboratory report) provides a good model, whereas adding cTnT and NTproBNP to clinical characteristics results in an excellent HF prediction model.
AB - BACKGROUND: Among the various cardiovascular diseases, heart failure (HF) is projected to have the largest increases in incidence over the coming decades; therefore, improving HF prediction is of significant value. Weevaluated whether cardiac troponin T (cTnT) measured with a high-sensitivity assay and N-terminal pro-B-type natriuretic peptide (NT-proBNP), biomarkers strongly associated with incident HF, improve HF risk prediction in the Atherosclerosis Risk in Communities (ARIC) study. METHODS: Using sex-specific models, we added cTnT and NT-proBNP to age and race ("laboratory report" model) and to the ARIC HF model (includes age, race, systolic blood pressure, antihypertensive medication use, current/former smoking, diabetes, body mass index, prevalent coronary heart disease, and heart rate) in 9868 participants without prevalent HF; area under the receiver operating characteristic curve (AUC), integrated discrimination improvement, net reclassification improvement (NRI), and model fit were described. RESULTS: Over a mean follow-up of 10.4 years, 970 participants developed incident HF. Adding cTnT and NT-proBNP to the ARIC HF model significantly improved all statistical parameters (AUCs increased by 0.040 and 0.057; the continuous NRIs were 50.7% and 54.7% in women and men, respectively). Interestingly, the simpler laboratory report model was statistically no different than the ARIC HF model. CONCLUSIONS: cTnT and NT-proBNP have significant value in HF risk prediction. A simple sex-specific model that includes age, race, cTnT, and NT-proBNP (which can be incorporated in a laboratory report) provides a good model, whereas adding cTnT and NTproBNP to clinical characteristics results in an excellent HF prediction model.
UR - http://www.scopus.com/inward/record.url?scp=84889041779&partnerID=8YFLogxK
U2 - 10.1373/clinchem.2013.203638
DO - 10.1373/clinchem.2013.203638
M3 - Article
C2 - 24036936
AN - SCOPUS:84889041779
SN - 0009-9147
VL - 59
SP - 1802
EP - 1810
JO - Clinical Chemistry
JF - Clinical Chemistry
IS - 12
ER -