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

Division of Cardiology, Department of Medicine, University of California at San Diego, San Diego, California, USA.
Journal of the American College of Cardiology (Impact Factor: 16.5). 08/2008; 52(6):450-9. DOI: 10.1016/j.jacc.2008.04.033
Source: PubMed

ABSTRACT 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.
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.
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.
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.
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.

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Available from: Gail Laughlin, Sep 26, 2015
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    • "Interestingly, cTn levels correlate with the infarct size and prognosis [5]. Although cTns are excellent biomarkers they lack the ability to discriminate ACS and MI from other clinical syndromes [6]. There exist considerable variations in the specificity and sensitivity of the assays. "
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    02/2015; 2015:1-10. DOI:10.1155/2015/821823
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    • "Regarding the association between natriuretic peptides and mortality, our results point to an independent prognostic value of BNP, in agreement with other population-based studies which investigated the role of different NPs as determinants of overall and cause-specific death in older adults [10] [45] [46], including a previous investigation in the elderly with Chagas disease in the BHAS [47]. However, none of these studies with CRP or BNP performed measures of the incremental value of the biomarker in predicting overall mortality. "
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    PLoS ONE 09/2013; 8(9):e75809. DOI:10.1371/journal.pone.0075809 · 3.23 Impact Factor
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    • "e l s e v i e r . c o m / l o c a t e / m e c h a g e d e v in old age (Alcalai et al., 2007; Daniels et al., 2008; Agewall et al., 2011). Thus, there still remains the diagnostic dilemma over whether increasingly sensitive assays will result in a low specificity, increasing AMI false positives (Eggers et al., 2009). "
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