Association of High-Sensitivity Cardiac Troponins (hs-cTn) and the Risk of New-onset Heart Failure

Vellayat Ali, M.D.
By Vellayat Ali, M.D. on

A recent study, published in the Journal of American College of Cardiology, concluded that there is a strong association of high sensitivity cardiac troponin (hs-cTn) with the risk of new-onset heart failure (HF), independent of population at risk, cardiovascular risk factors, and natriuretic peptide levels.

HF is one of the leading cause of patient mortality and morbidity among cardiac patients. Although there are detailed guidelines for its management, prediction tools to recognize individuals at high risk are not included in preventive guidelines and hence not practiced clinically. Identifying such markers is important as HF is associated with poor survival, reduced quality of life, and results in enormous economic burden. This study collected the available data to review the association between hs-cTn and incident HF, and also to evaluate the added value of hs-cTn in its prediction.

The study is a systematic review and meta-analysis of 16 prospective studies with a total of 67,063 subjects and 4165 incident HF. Data was collated on population type, mean age, sex, ethnicity, baseline history of hypertension, diabetes, or cardiovascular disease, hs-cTn assay type and manufacturer, number of participants, duration of follow-up, and number of incident HF events.

Using Hs-cTn will increase the efficacy of HF screening using echocardiography by targeting patients with high levels of Hs-cTn with increased risk of developing HF.

Results of the analysis showed that there was a strong association between hs-cTn and the development of incident HF. Individuals with hs-cTn values in the top third of the population had a >2-fold increase in risk for developing HF as compared to the bottom third. The pooled Hazards ratio-HR was 2.09 (95% confidence interval [CI]: 1.76 to 2.48; p <0.0001), which didn’t change appreciably after adjusting for B-type natriuretic peptide and traditional cardiovascular risk factors. Furthermore, upon assessment of hs-cTn in addition to usual CVD risk factors, an improvement was seen in risk discrimination as quantified with the concordance index (0.01 to 0.03).

The authors conclude that using Hs-cTn will increase the efficacy of HF screening using echocardiography by targeting patients with high levels of Hs-cTn with increased risk of developing HF.

The authors also mention that natriuretic peptides have been used to predict the development of HF and to assess the prognosis. However, studies that have led to this did not adjust for the presence of high levels of Hs-cTn. On the other hand, the current meta-analysis indicated that Hs-cTn is associated with incident HF independent from high levels of natriuretic peptides. They also mention that the association between Hs-cTn and the development of new HF is stronger than its association with the development of stroke or coronary heart disease.

Evans et al. report the heterogeneity among the studies included in the meta-analysis as the biggest limitation of the study. This heterogeneity did not allow the assumption of normal distribution of the variables of exposure and thus the assumption of the presence of a linear relationship between Hs-cTn and these variables. 

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