High-sensitivity cardiac troponin and new-onset heart failure: a systematic review and meta-analysis of 67,063 patients with 4,165 incident heart failure events

Evans, J. D.W., Dobbin, S. J.H. , Pettit, S. J., Di Angelantonio, E. and Willeit, P. (2018) High-sensitivity cardiac troponin and new-onset heart failure: a systematic review and meta-analysis of 67,063 patients with 4,165 incident heart failure events. JACC: Heart Failure, 6(3), pp. 187-197. (doi: 10.1016/j.jchf.2017.11.003) (PMID:29331272)

Abstract

Objectives: The aim of this study was to systematically collate and appraise the available evidence regarding the association between high-sensitivity cardiac troponin (hs-cTn) and incident heart failure (HF) and the added value of hs-cTn in HF prediction. Background: Identification of subjects at high risk for HF and early risk factor modification with medications such as angiotensin-converting enzyme inhibitors may delay the onset of HF. Hs-cTn has been suggested as a prognostic marker for the incidence of first-ever HF in asymptomatic subjects. Methods: PubMed, Embase, and Web of Science were systematically searched for prospective cohort studies published before January 2017 that reported associations between hs-cTn and incident HF in subjects without baseline HF. Study-specific multivariate-adjusted hazard ratios (HRs) were pooled using random-effects meta-analysis. Results: Data were collated from 16 studies with a total of 67,063 subjects and 4,165 incident HF events. The average age was 57 years, and 47% were women. Study quality was high (Newcastle-Ottawa score 8.2 of 9). In a comparison of participants in the top third with those in the bottom third of baseline values of hs-cTn, the pooled multivariate-adjusted HR for incident HF was 2.09 (95% confidence interval [CI]: 1.76 to 2.48; p < 0.001). Between-study heterogeneity was high, with an I2 value of 80%. HRs were similar in men and women (2.29 [95% CI: 1.64 to 3.21] vs. 2.18 [95% CI: 1.68 to 2.81]) and for hs-cTnI and hs-cTnT (2.09 [95% CI: 1.53 to 2.85] vs. 2.11 [95% CI: 1.69 to 2.63]) and across other study-level characteristics. Further adjustment for B-type natriuretic peptide yielded a similar HR of 2.08 (95% CI: 1.64 to 2.65). Assay of hs-cTn in addition to conventional risk factors provided improvements in the C index of 1% to 3%. Conclusions: Available prospective studies indicate a strong association of hs-cTn with the risk of first-ever HF and significant improvements in HF prediction.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Dobbin, Dr Stephen
• Authors: Evans, J. D.W., Dobbin, S. J.H., Pettit, S. J., Di Angelantonio, E., and Willeit, P.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
• Journal Name: JACC: Heart Failure
• Publisher: Elsevier
• ISSN: 2213-1779
• ISSN (Online): 2213-1787
• Published Online: 10 January 2018
• Copyright Holders: Copyright © 2018 American College of Cardiology Foundation
• First Published: First published in JACC: Heart Failure 6(3): 187-197
• Publisher Policy: Reproduced in accordance with the publisher copyright policy