Minimally Elevated Cardiac Troponin T and Elevated N-Terminal Pro-B-Type Natriuretic Peptide Predict Mortality in Older Adults

Daniels, Lori B.; Laughlin, Gail A.; Clopton, Paul; Maisel, Alan S.; Barrett‐Connor, Elizabeth

doi:10.1016/j.jacc.2008.04.033

Cited by 172 publications

(147 citation statements)

References 47 publications

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“…Study subjects were stratified into two cohorts depending on the absence or presence of detectable ( ≥ 10 ng/L) TnT and followed for mortality through 2006. Those with detectable baseline TnT were at increased risk of death compared to subjects with undetectable TnT, and this increased risk persisted for years [84]. Importantly, this conclusion was not only valid for the complete patient cohort, which included patients with known CAD, but also for the adults with no signs and symptoms of CAD at enrollment.…”

Section: Prognostic Applications Of Medium Sensitivity Ctn Assaysmentioning

confidence: 74%

High sensitivity cardiac troponin assays in the clinical laboratories

Jarolím

2015

Clinical Chemistry and Laboratory Medicine (CCLM)

117

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Abstract:Immunoassays measuring cardiac troponins I or T have become firmly established as critical tools for diagnosing acute myocardial infarction. While most contemporary assays provide adequate diagnostic performance, the increased sensitivity and precision of the new, high sensitivity assays that have already been introduced into clinical practice, provide the potential to further shorten intervals between blood draws or the time needed to detect the first significant troponin elevation. In addition to the relatively modest benefits at the diagnostic end, the high sensitivity assays and the investigational ultrasensitive cardiac troponin assays offer improvements for predicting major adverse cardiovascular events, development of heart failure or transition to end-stage kidney disease. These novel high sensitivity assays can measure troponin concentrations in 50%-100% of healthy individuals and therefore allow for the distribution of troponin values within a healthy cohort to be measured, patient's baseline troponin levels to be monitored, and clinicians to be alerted of deteriorating cardiorenal conditions. We envisage that the high sensitivity assays will become important tools for predicting each patient's risk of future adverse events and for guiding and monitoring corresponding adjustments of preventative therapeutic interventions.

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Section: Prognostic Applications Of Medium Sensitivity Ctn Assaysmentioning

confidence: 74%

High sensitivity cardiac troponin assays in the clinical laboratories

Jarolím

2015

Clinical Chemistry and Laboratory Medicine (CCLM)

117

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“…Elevated levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP) and troponin T (TnT) are associated with adverse outcomes, including incident heart failure (HF), major cardiovascular events, and mortality (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12). NT-proBNP is secreted into the circulation from cardiac myocytes in response to stimuli, such as pressure or volume overload (13).…”

Section: Introductionmentioning

confidence: 99%

NT-ProBNP and Troponin T and Risk of Rapid Kidney Function Decline and Incident CKD in Elderly Adults

Bansal

Katz

Dalrymple

et al. 2015

Clinical Journal of the American Society of Nephrology

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Background and objectives Elevations in N-terminal pro-B-type natriuretic peptide and high-sensitivity troponin T are associated with poor cardiovascular outcomes. Whether elevations in these cardiac biomarkers are associated with decline in kidney function was evaluated.Design, setting, participants, & measurements N-terminal pro-B-type natriuretic peptide and troponin T were measured at baseline in 3752 participants free of heart failure in the Cardiovascular Health Study. eGFR was determined from the Chronic Kidney Disease Epidemiology Collaboration equation using serum cystatin C. Rapid decline in kidney function was defined as decline in serum cystatin C eGFR$30%, and incident CKD was defined as the onset of serum cystatin C eGFR,60 among those without CKD at baseline (n=2786). Cox regression models were used to examine the associations of each biomarker with kidney function decline adjusting for demographics, baseline serum cystatin C eGFR, diabetes, and other CKD risk factors.Results In total, 503 participants had rapid decline in serum cystatin C eGFR over a mean follow-up time of 6.41 (1.81) years, and 685 participants developed incident CKD over a mean follow-up time of 6.41 (1.74) years. Participants in the highest quartile of N-terminal pro-B-type natriuretic peptide (.237 pg/ml) had an 67% higher risk of rapid decline and 38% higher adjusted risk of incident CKD compared with participants in the lowest quartile (adjusted hazard ratio for serum cystatin C eGFR rapid decline, 1.67; 95% confidence interval, 1.25 to 2.23; hazard ratio for incident CKD, 1.38; 95% confidence interval, 1.08 to 1.76). Participants in the highest category of troponin T (.10.58 pg/ml) had 80% greater risk of rapid decline compared with participants in the lowest category (adjusted hazard ratio, 1.80; 95% confidence interval, 1.35 to 2.40). The association of troponin T with incident CKD was not statistically significant (hazard ratio, 1.17; 95% confidence interval, 0.92 to 1.50).Conclusions Elevated N-terminal pro-B-type natriuretic peptide and troponin T are associated with rapid decline of kidney function and incident CKD. Additional studies are needed to evaluate the mechanisms that may explain this association.

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“…Nevertheless, prior studies have demonstrated that all-cause and cardiac mortality are equally robust, most likely because of the strong association between these two outcomes in cardiac surgical populations. 33,34 CONCLUSION hFABP is superior to cTnI, CK-MB, and myoglobin for predicting up to 5-year all-cause mortality and ventricular dysfunction and is comparable with these biomarkers of myocardial injury for predicting HLOS after CABG surgery with CPB, even after adjusting for relevant demographic and clinical predictors. In addition, with its rapid increase and decrease, hFABP may allow diagnosis of continuing or recurring myocardial injury after cardiac surgery and therefore may permit more timely initiation of specific treatment strategies.…”

Section: Study Limitationsmentioning

confidence: 92%