CLINICAL RESEARCH: BIOMARKERS
Minimally Elevated Cardiac Troponin T and Elevated N-Terminal Pro-B-Type Natriuretic Peptide Predict Mortality in Older AdultsResults From the Rancho Bernardo Study
Lori B. Daniels, MD, MAS*,*,
Gail A. Laughlin, PhD ,
Paul Clopton, MS*, ,
Alan S. Maisel, MD, FACC*, and
Elizabeth Barrett-Connor, MD
* Division of Cardiology, Department of Medicine, University of California at San Diego, San Diego, California
Department of Family and Preventive Medicine, University of California at San Diego, San Diego, California
Veteran's Affairs San Diego Healthcare System, La Jolla, California.
Manuscript received January 18, 2008;
revised manuscript received April 23, 2008,
accepted April 27, 2008.
* Reprint requests and correspondence: Dr. Lori B. Daniels, Mail Code 0986, 9350 Campus Point Drive, Suite 1D, La Jolla, California 92037-1300. (Email: lbdaniels{at}ucsd.edu).
Objectives: This study investigated the prognostic value of detectable cardiac troponin T (TnT) and elevated N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels in a population of community-dwelling older adults.
Background: Minimally elevated levels of TnT, a marker of cardiomyocyte injury, have been found in small subsets of the general population, with uncertain implications. A marker of ventricular stretch, NT-proBNP has clinical utility in many venues, but its long-term prognostic value in apparently healthy older adults and in conjunction with TnT is unknown.
Methods: Participants were 957 older adults from the Rancho Bernardo Study with plasma NT-proBNP and TnT measured at baseline (1997 to 1999) and followed up for mortality through July 2006.
Results: Participants with detectable TnT ( 0.01 ng/ml, n = 39) had an increased risk of all-cause and cardiovascular death (adjusted hazard ratio [HR] by Cox proportional hazards analysis: 2.06; 95% confidence interval [CI]: 1.29 to 3.28, p = 0.003 for all-cause mortality; HR: 2.06, 95% CI: 1.03 to 4.12, p = 0.040 for cardiovascular mortality); elevated NT-proBNP also predicted an increased risk of all-cause and cardiovascular mortality (adjusted HR per unit-log increase in NT-proBNP: 1.85, 95% CI: 1.36 to 2.52, p < 0.001 for all-cause mortality; HR: 2.51, 95% CI: 1.55 to 4.08, p < 0.001 for cardiovascular mortality). Those with both elevated NT-proBNP and detectable TnT had poorer survival (HR for high NT-proBNP and detectable TnT vs. low NT-proBNP and any TnT: 3.20, 95% CI: 1.91 to 5.38, p < 0.001). Exclusion of the 152 participants with heart disease at baseline did not materially change the TnT mortality or NT-proBNP mortality associations.
Conclusions: Apparently healthy adults with detectable TnT or elevated NT-proBNP levels are at increased risk of death. Those with both TnT and NT-proBNP elevations are at even higher risk, and the increased risk persists for years.
Key Words: aging cardiovascular diseases epidemiology natriuretic peptides prognosis risk factors survival
|
Abbreviations and Acronyms
| | AUC = area under the receiver-operator characteristic curve | | BMI = body mass index | | BUN = blood urea nitrogen | | CHD = coronary heart disease | | CVD = cardiovascular disease | | HR = hazard ratio | | NT-proBNP = N-terminal pro-B-type natriuretic peptide | | ROC = receiver-operator characteristic | | TnT = troponin T |
|
Related Article
-
Inside This Issue of JACC
J. Am. Coll. Cardiol. 2008 52: A31-A32.
[Full Text]
[PDF]
This article has been cited by other articles:

|
 |

|
 |
 
J. Rubin, K. Matsushita, C. M. Ballantyne, R. Hoogeveen, J. Coresh, and E. Selvin
Chronic Hyperglycemia and Subclinical Myocardial Injury
J. Am. Coll. Cardiol.,
January 31, 2012;
59(5):
484 - 489.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
A. T. Turer, T. A. Addo, J. L. Martin, M. S. Sabatine, G. D. Lewis, R. E. Gerszten, E. C. Keeley, J. E. Cigarroa, R. A. Lange, L. D. Hillis, et al.
Myocardial Ischemia Induced by Rapid Atrial Pacing Causes Troponin T Release Detectable by a Highly Sensitive Assay: Insights From a Coronary Sinus Sampling Study
J. Am. Coll. Cardiol.,
June 14, 2011;
57(24):
2398 - 2405.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
S. J. Aldous, C. M. Florkowski, I. G. Crozier, P. George, R. Mackay, and M. Than
High sensitivity troponin outperforms contemporary assays in predicting major adverse cardiac events up to two years in patients with chest pain
Ann Clin Biochem,
May 1, 2011;
48(3):
249 - 255.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
J. T. Saunders, V. Nambi, J. A. de Lemos, L. E. Chambless, S. S. Virani, E. Boerwinkle, R. C. Hoogeveen, X. Liu, B. C. Astor, T. H. Mosley, et al.
Cardiac Troponin T Measured by a Highly Sensitive Assay Predicts Coronary Heart Disease, Heart Failure, and Mortality in the Atherosclerosis Risk in Communities Study
Circulation,
April 5, 2011;
123(13):
1367 - 1376.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
E. J. van den Bos, A. A. Constantinescu, R. T. van Domburg, S. Akin, L. J. Jordaens, and M. J. M. Kofflard
Minor elevations in troponin I are associated with mortality and adverse cardiac events in patients with atrial fibrillation
Eur. Heart J.,
March 1, 2011;
32(5):
611 - 617.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
Y. Xue, P. Clopton, W. F. Peacock, and A. S. Maisel
Serial changes in high-sensitive troponin I predict outcome in patients with decompensated heart failure
Eur J Heart Fail,
January 1, 2011;
13(1):
37 - 42.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
Writing Committee Members, P. Greenland, J. S. Alpert, G. A. Beller, E. J. Benjamin, M. J. Budoff, Z. A. Fayad, E. Foster, M. A. Hlatky, J. M. Hodgson, et al.
2010 ACCF/AHA Guideline for Assessment of Cardiovascular Risk in Asymptomatic Adults: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines
Circulation,
December 21, 2010;
122(25):
e584 - e636.
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
P. Greenland, J. S. Alpert, G. A. Beller, E. J. Benjamin, M. J. Budoff, Z. A. Fayad, E. Foster, M. A. Hlatky, J. M. Hodgson, F. G. Kushner, et al.
2010 ACCF/AHA Guideline for Assessment of Cardiovascular Risk in Asymptomatic Adults: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines Developed in Collaboration With the American Society of Echocardiography, American Society of Nuclear Cardiology, Society of Atherosclerosis Imaging and Prevention, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, and Society for Cardiovascular Magnetic Resonance
J. Am. Coll. Cardiol.,
December 14, 2010;
56(25):
e50 - e103.
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
L. B. Daniels and A. S. Maisel
Multiple marker approach to risk stratification in patients with stable coronary artery disease: to have or have not
Eur. Heart J.,
December 2, 2010;
31(24):
2980 - 2983.
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
A. S. Jaffe
Chapter 33 The use of biomarkers for acute cardiovascular disease
The ESC Textbook of Acute and Intensive Cardiac Care,
December 1, 2010;
1(1):
med-9780199584314-chapter - med-9780199584314-chapter.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
U. Alehagen, U. Dahlstrom, J. F. Rehfeld, and J. P. Goetze
Prognostic Assessment of Elderly Patients with Symptoms of Heart Failure by Combining High-Sensitivity Troponin T and N-Terminal Pro-B-Type Natriuretic Peptide Measurements
Clin. Chem.,
November 1, 2010;
56(11):
1718 - 1724.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
J. D. Muehlschlegel, T. E. Perry, K.-Y. Liu, A. A. Fox, C. D. Collard, S. K. Shernan, and S. C. Body
Heart-Type Fatty Acid Binding Protein Is an Independent Predictor of Death and Ventricular Dysfunction After Coronary Artery Bypass Graft Surgery
Anesth. Analg.,
November 1, 2010;
111(5):
1101 - 1109.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
K. Thygesen, J. Mair, H. Katus, M. Plebani, P. Venge, P. Collinson, B. Lindahl, E. Giannitsis, Y. Hasin, M. Galvani, et al.
Recommendations for the use of cardiac troponin measurement in acute cardiac care
Eur. Heart J.,
September 2, 2010;
31(18):
2197 - 2204.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
J. A. de Lemos and A. Rohatgi
Separating the Contenders From the Pretenders: Competitive High-Throughput Biomarker Screening in Large Population-Based Studies
Circulation,
June 8, 2010;
121(22):
2381 - 2383.
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
W. H. W. Tang, Y. Wu, S. J. Nicholls, D. M. Brennan, M. Pepoy, S. Mann, A. Pratt, F. Van Lente, and S. L. Hazen
Subclinical Myocardial Necrosis and Cardiovascular Risk in Stable Patients Undergoing Elective Cardiac Evaluation
Arterioscler Thromb Vasc Biol,
March 1, 2010;
30(3):
634 - 640.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
J. H.W. Rutten, F. U.S. Mattace-Raso, E. W. Steyerberg, J. Lindemans, A. Hofman, R. G. Wieberdink, M. M.B. Breteler, J. C.M. Witteman, and A. H. van den Meiracker
Amino-Terminal Pro-B-Type Natriuretic Peptide Improves Cardiovascular and Cerebrovascular Risk Prediction in the Population: The Rotterdam Study
Hypertension,
March 1, 2010;
55(3):
785 - 791.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
E. Giannitsis, K. Kurz, K. Hallermayer, J. Jarausch, A. S. Jaffe, and H. A. Katus
Analytical Validation of a High-Sensitivity Cardiac Troponin T Assay
Clin. Chem.,
February 1, 2010;
56(2):
254 - 261.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
E. Di Angelantonio, R. Chowdhury, N. Sarwar, K. K. Ray, R. Gobin, D. Saleheen, A. Thompson, V. Gudnason, N. Sattar, and J. Danesh
B-Type Natriuretic Peptides and Cardiovascular Risk: Systematic Review and Meta-Analysis of 40 Prospective Studies
Circulation,
December 1, 2009;
120(22):
2177 - 2187.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
M. Bonham and S. Miller
Clinical Comparison of 99th Percentile and 10% Coefficient of Variation Cutoff Values for Four Commercially Available Troponin I Assays
Lab Med,
August 1, 2009;
40(8):
470 - 473.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
J. D. Muehlschlegel, T. E. Perry, K.-Y. Liu, L. Nascimben, A. A. Fox, C. D. Collard, E. G. Avery, S. F. Aranki, M. N. D'Ambra, S. K. Shernan, et al.
Troponin is superior to electrocardiogram and creatinine kinase MB for predicting clinically significant myocardial injury after coronary artery bypass grafting
Eur. Heart J.,
July 1, 2009;
30(13):
1574 - 1583.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
Y. R.B.M. van Gestel, D. D. Sin, and D. Poldermans
Elevated N-Terminal Pro-B-Type Natriuretic Peptide Levels: The Effect of Chronic Obstructive Pulmonary Disease
J. Am. Coll. Cardiol.,
February 3, 2009;
53(5):
458 - 458.
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
L. B. Daniels, G. A. Laughlin, P. Clopton, A. S. Maisel, and E. Barrett-Connor
Reply
J. Am. Coll. Cardiol.,
February 3, 2009;
53(5):
458 - 459.
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
H.A. Katus, E. Giannitsis, A.S. Jaffe, and K. Thygesen
Higher sensitivity troponin assays: Quo vadis?
Eur. Heart J.,
January 2, 2009;
30(2):
127 - 128.
[Full Text]
[PDF]
|
 |
|
|