title: Head-to-head comparison of high-sensitivity troponin T and sensitive-contemporary troponin I regarding heart failure risk stratification.
abstract: BACKGROUND
  High-sensitivity assays for cardiac troponins have recently become available, increasing the value of troponins in heart failure (HF) prognostication. We head-to-head compared the prognostic significance of high-sensitivity cardiac troponin T (hs-cTnT) and sensitive-contemporary cardiac troponin I (sc-cTnI) in an outpatient HF population.
  
  
  METHODS
  We studied 876 patients, mainly of ischemic etiology (52.1%). Median left ventricular ejection fraction was 34%. Median follow-up was 3.45 years. Comprehensive statistical measurements of performance (discrimination, calibration, and reclassification) were obtained.
  
  
  RESULTS
  hs-cTnT was ubiquitous in the patient cohort; sc-cTnI was detected in 276 patients (31.5%). During follow-up 311 patients died. According to multivariable Cox regression analysis, both hs-cTnT (HR 2.09, 95% CI 1.46-2.99, P<0.001) and sc-cTnI (HR 1.61, 95% CI 1.24-2.08, P<0.001) remained independent predictors of all cause and cardiovascular mortality. Using the best predictive cut-off point for both troponins calibration was better for hs-cTnT, which also reclassified a larger number of patients (NRI 9.0 [2.5;15.5] P = 0.007). The higher sensitivity of hs-cTnT permitted the identification of almost the double of deaths.
  
  
  CONCLUSIONS
  Both hs-cTnT and sc-cTnI predict mortality in a real-life cohort of ambulatory HF patients. However, hs-cTnT showed globally better measures of performance and identified a higher proportion of decedents during follow-up.
authors: Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain; Department of Medicine, Autonomous University of Barcelona, Spain.
authors: Marta
authors: M
authors: de Antonio
authors: Josep
authors: J
authors: Lupón
authors: Amparo
authors: A
authors: Galán
authors: Joan
authors: J
authors: Vila
authors: Elisabet
authors: E
authors: Zamora
authors: Agustín
authors: A
authors: Urrutia
authors: Crisanto
authors: C
authors: Díez
authors: Ramon
authors: R
authors: Coll
authors: Salvador
authors: S
authors: Altimir
authors: Antoni
authors: A
authors: Bayes-Genis
mesh_terms: D000368:Aged; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000175:diagnosis; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012307:Risk Factors; D012680:Sensitivity and Specificity; D019210:Troponin I / Q000097:blood*; D020107:Troponin T / Q000097:blood*
chemical_list: D019210:Troponin I; D020107:Troponin T
keywords: ACEI; AIC; ARB; AUC; Akaike information criterion; BIC; Bayesian information criterion; Cardiac troponins; HF; Heart failure; IDI; LVEF; N-terminal pro-brain natriuretic peptide; NRI; NTproBNP; Prognosis; Survival; angiotensin II receptor blocker; angiotensin-converting enzyme inhibitor; area under the receiver-operating characteristic curve; eGFR; estimated glomerular filtration rate; heart failure; high-sensitivity cardiac troponin T; hs-cTnT; integrated discrimination improvement; left ventricular ejection fraction; net reclassification improvement; sc-cTnI; sensitive-contemporary cardiac troponin I