title: Troponin T and N-terminal pro-B-type natriuretic peptide: a biomarker approach to predict heart failure risk--the atherosclerosis risk in communities study.
abstract: BACKGROUND
  Among the various cardiovascular diseases, heart failure (HF) is projected to have the largest increases in incidence over the coming decades; therefore, improving HF prediction is of significant value. We evaluated whether cardiac troponin T (cTnT) measured with a high-sensitivity assay and N-terminal pro-B-type natriuretic peptide (NT-proBNP), biomarkers strongly associated with incident HF, improve HF risk prediction in the Atherosclerosis Risk in Communities (ARIC) study.
  
  
  METHODS
  Using sex-specific models, we added cTnT and NT-proBNP to age and race ("laboratory report" model) and to the ARIC HF model (includes age, race, systolic blood pressure, antihypertensive medication use, current/former smoking, diabetes, body mass index, prevalent coronary heart disease, and heart rate) in 9868 participants without prevalent HF; area under the receiver operating characteristic curve (AUC), integrated discrimination improvement, net reclassification improvement (NRI), and model fit were described.
  
  
  RESULTS
  Over a mean follow-up of 10.4 years, 970 participants developed incident HF. Adding cTnT and NT-proBNP to the ARIC HF model significantly improved all statistical parameters (AUCs increased by 0.040 and 0.057; the continuous NRIs were 50.7% and 54.7% in women and men, respectively). Interestingly, the simpler laboratory report model was statistically no different than the ARIC HF model.
  
  
  CONCLUSIONS
  cTnT and NT-proBNP have significant value in HF risk prediction. A simple sex-specific model that includes age, race, cTnT, and NT-proBNP (which can be incorporated in a laboratory report) provides a good model, whereas adding cTnT and NT-proBNP to clinical characteristics results in an excellent HF prediction model.
authors.affiliation: Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX;
authors.forename: Vijay
authors.initials: V
authors.lastname: Nambi
authors.forename: Xiaoxi
authors.initials: X
authors.lastname: Liu
authors.forename: Lloyd E
authors.initials: LE
authors.lastname: Chambless
authors.forename: James A
authors.initials: JA
authors.lastname: de Lemos
authors.forename: Salim S
authors.initials: SS
authors.lastname: Virani
authors.forename: Sunil
authors.initials: S
authors.lastname: Agarwal
authors.forename: Eric
authors.initials: E
authors.lastname: Boerwinkle
authors.forename: Ron C
authors.initials: RC
authors.lastname: Hoogeveen
authors.forename: David
authors.initials: D
authors.lastname: Aguilar
authors.forename: Brad C
authors.initials: BC
authors.lastname: Astor
authors.forename: Pothur R
authors.initials: PR
authors.lastname: Srinivas
authors.forename: Anita
authors.initials: A
authors.lastname: Deswal
authors.forename: Thomas H
authors.initials: TH
authors.lastname: Mosley
authors.forename: Josef
authors.initials: J
authors.lastname: Coresh
authors.forename: Aaron R
authors.initials: AR
authors.lastname: Folsom
authors.forename: Gerardo
authors.initials: G
authors.lastname: Heiss
authors.forename: Christie M
authors.initials: CM
authors.lastname: Ballantyne
mesh_terms: D000368:Aged; D050197:Atherosclerosis / Q000097:blood*; D015415:Biomarkers / Q000097:blood*; D005260:Female; D006333:Heart Failure / Q000097:blood*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011498:Protein Precursors / Q000097:blood*; D012307:Risk Factors; D012680:Sensitivity and Specificity; D020107:Troponin T / Q000097:blood*
chemical_list: D015415:Biomarkers; D011498:Protein Precursors; D020107:Troponin T; D020097:Natriuretic Peptide, Brain
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