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.
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Figure 1 NT-proBNP Levels and Creatinine Clearance Levels by Troponin T Category
Troponin T categories: undetectable, n = 917; low, n = 30; high, n = 9. Boxes depict interquartile range, and whiskers represent 10th and 90th percentiles. *p < 0.001 versus undetectable. p < 0.001 versus undetectable and p = 0.03 versus low. p < 0.001 versus low and p = 0.02 versus high. NT-proBNP = N-terminal pro-B-type natriuretic peptide.
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Figure 2 Prevalence of Baseline CHD and Distribution of TnT and NT-proBNP
(A) Prevalence of baseline coronary heart disease (CHD) in participants with undetectable and detectable TnT levels (left), and distribution of TnT among those with detectable levels (right). (B) Prevalence of baseline CHD in participants with low versus high NT-proBNP levels (left), and distribution of NT-proBNP among all subjects (right). NT-proBNP = N-terminal pro-B-type natriuretic peptide; prior CHD = myocardial infarction or revascularization; TnT = troponin T.
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Figure 3 Kaplan-Meier Survival Plots by TnT or NT-proBNP Levels
(A) Survival in participants with undetectable versus detectable TnT levels. n = 196 deaths in the undetectable TnT group (of 917 participants with undetectable TnT) and n = 23 deaths in the detectable TnT group (of 39 participants with detectable TnT). (B) Survival in participants with undetectable versus detectable TnT levels, with analysis limited to those participants without baseline coronary heart disease (CHD). n = 143 deaths in the undetectable TnT group (of 781 participants with undetectable TnT) and n = 13 deaths in the detectable TnT group (of 24 participants with detectable TnT). (C) Survival in participants with low (<450 pg/ml) versus high ( 450 pg/ml) NT-proBNP levels. n = 132 deaths in the low NT-proBNP group (of 758 participants with low NT-proBNP) and n = 88 deaths in the high NT-proBNP group (of 199 participants with high NT-proBNP). (D) Survival in participants with low versus high NT-proBNP levels, with analysis limited to those participants without baseline CHD. n = 106 deaths in the low NT-proBNP group (of 667 participants with low NT-proBNP) and n = 51 deaths in the high NT-proBNP group (of 139 participants with high NT-proBNP). Abbreviations as in Figure 2.
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Figure 4 Kaplan-Meier Survival Plots by Combined TnT and NT-proBNP Levels
(A) n = 132 deaths in the high NT-proBNP/detectable TnT group, n = 68 deaths in the high NT-proBNP/undetectable TnT group, and n = 19 deaths in the low NT-proBNP group. (B) Analysis limited to those participants without baseline coronary heart disease (CHD). n = 106 deaths in the high NT-proBNP/detectable TnT group, n = 40 deaths in the high NT-proBNP/undetectable TnT group, and n = 10 deaths in the low NT-proBNP group. Abbreviations as in Figure 2.
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Figure 5 Framingham Risk Score and Incremental Prognostic Value of Troponin T or NT-proBNP for Predicting Death
Reference group in (A) is the group with low Framingham risk score (<10%) and undetectable troponin T. Reference group in (B) is the group with low Framingham risk scores and NT-proBNP <450 pg/ml. Framingham risk score was calculated as low risk (<10% risk of events over 10 years), moderate risk (10% to 20%), and high risk (>20%). Abbreviations as in Figure 2.
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