Clinical determinants of plasma cardiac biomarkers in patients with stable chest pain

Bing, R. et al. (2019) Clinical determinants of plasma cardiac biomarkers in patients with stable chest pain. Heart, 105(22), pp. 1748-1754. (doi: 10.1136/heartjnl-2019-314892) (PMID:31154425) (PMCID:PMC6855840)

Abstract

Objective: Troponin and B-type natriuretic peptide (BNP) concentrations are associated with cardiovascular risk in stable patients. Understanding their determinants and identifying modifiable clinical targets may improve outcomes. We aimed to establish clinical and cardiac determinants of these biomarkers. Methods: This was a prespecified substudy from the randomised Scottish Computed Tomography of the Heart trial, which enrolled patients 18–75 years with suspected stable angina between 2010 and 2014 (NCT01149590). We included patients from six centres in whom high-sensitivity troponin I and BNP were measured (Singulex Erenna). Patients with troponin >99th centile upper reference limit (10.2 ng/L) or BNP ≥400 ng/L were excluded to avoid inclusion of patients with myocardial injury or heart failure. Multivariable linear regression models were constructed with troponin and BNP as dependent variables. Results: In total, 885 patients were included; 881 (99%) and 847 (96%) had troponin and BNP concentrations above the limit of detection, respectively. Participants had a slight male preponderance (n=513; 56.1%), and the median age was 59.0 (IQR 51.0–65.0) years. The median troponin and BNP concentrations were 1.4 (IQR 0.90–2.1) ng/L and 29.1 (IQR 14.0–54.0) ng/L, respectively. Age and atherosclerotic burden were independent predictors of both biomarkers. Male sex, left ventricular mass and systolic blood pressure were independent predictors of increased troponin. In contrast, female sex and left ventricular volume were independent predictors of increased BNP. Conclusions: Troponin and BNP are associated with coronary atherosclerosis but have important sex differences and distinct and contrasting associations with CT-determined left ventricular mass and volume.

• Item Type: Articles
• Additional Information: Funding The Chief Scientist Office of the Scottish Government (CZH/4/588) funded the SCOT-HEART trial with supplementary support from the British Heart Foundation (RE/13/3/30183), Edinburgh and Lothians Health Foundation Trust, and the Heart Diseases Research Fund. DEN (CH/09/002, RE/18/5/34216), NLM (FS/16/14/32023) and MRD (FS/14/78/31020) are supported by the British Heart Foundation. DEN is also the recipient of a Wellcome Trust Senior Investigator Award (WT103782AIA). MCW is supported by the Chief Scientist Office of the Scottish Government Health and Social Care Directorates (PCL/17/04). DM is supported by an Intermediate Clinical Fellowship and Beit Fellowship from the Wellcome Trust (201492/Z/16/Z).
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: McAllister, Professor David
• Authors: Bing, R., Henderson, J., Hunter, A., Williams, M. C., Moss, A. J., Shah, A. S.V., McAllister, D., Dweck, M. R., Newby, D. E., Mills, N. L., and Adamson, P. D.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Public Health
• Journal Name: Heart
• Publisher: BMJ Publishing Group
• ISSN: 1355-6037
• ISSN (Online): 1468-201X
• Published Online: 01 June 2019
• Copyright Holders: Copyright © 2019 The Authors
• First Published: First published in Heart 105(22):1748-1754
• Publisher Policy: Reproduced under a Creative Commons license