title: High-sensitivity troponin I and amino-terminal pro--B-type natriuretic peptide predict heart failure and mortality in the general population.
abstract: BACKGROUND
  High-sensitivity cardiac troponin assays have potent prognostic value in stable cardiovascular disease cohorts. Our objective was to assess the prognostic utility of a novel cardiac troponin I (cTnI) high-sensitivity assay, independently and in combination with amino-terminal pro-B-type natriuretic peptide (NT-proBNP), for the future development of heart failure and mortality in the general community.
  
  
  METHODS
  A well-characterized community-based cohort of 2042 participants underwent clinical assessment and echocardiographic evaluation. Baseline measurements of cTnI with a high-sensitivity assay and NT-proBNP were obtained in 1843 individuals. Participants were followed for new-onset heart failure and mortality with median (25th, 75th percentile) follow-up of 10.7 (7.9, 11.6) and 12.1 (10.4, 13.0) years, respectively.
  
  
  RESULTS
  When measured with a high-sensitivity assay, cTnI greater than the sex-specific 80th percentile was independently predictive of heart failure [hazard ratio 2.56 (95% confidence interval 1.88-3.50), P < 0.001] and mortality [1.91(1.49-2.46), P < 0.001] beyond conventional risk factors in this community-based cohort, with significant increases in the net reclassification improvement for heart failure. The prognostic utility of cTnI measured with a high-sensitivity assay goes beyond NT-proBNP, yet our data suggest that these 2 assays are complementary and most beneficial when evaluated together in identifying at-risk individuals in the community.
  
  
  CONCLUSIONS
  Our findings lay the foundation for prospective studies aimed at identification of individuals at high risk by use of a multimarker approach, followed by aggressive prevention strategies to prevent subsequent heart failure.
authors.affiliation: Cardiorenal Research Laboratory, Division of Cardiovascular Diseases, Department of Internal Medicine, mckie.paul@mayo.edu.
authors.forename: Paul M
authors.initials: PM
authors.lastname: McKie
authors.affiliation: Cardiorenal Research Laboratory, Division of Cardiovascular Diseases, Department of Internal Medicine.
authors.forename: Omar F
authors.initials: OF
authors.lastname: AbouEzzeddine
authors.affiliation: Division of Biostatistics, Department of Laboratory Medicine and Pathology, and.
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Scott
authors.affiliation: Division of Biostatistics, Department of Laboratory Medicine and Pathology, and.
authors.forename: Ramila
authors.initials: R
authors.lastname: Mehta
authors.affiliation: Cardiorenal Research Laboratory, Division of Cardiovascular Diseases, Department of Internal Medicine.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Rodeheffer
authors.affiliation: Cardiorenal Research Laboratory, Division of Cardiovascular Diseases, Department of Internal Medicine.
authors.forename: Margaret M
authors.initials: MM
authors.lastname: Redfield
authors.affiliation: Cardiorenal Research Laboratory, Division of Cardiovascular Diseases, Department of Internal Medicine.
authors.forename: John C
authors.initials: JC
authors.lastname: Burnett
authors.affiliation: Division of Cardiovascular Diseases, Department of Internal Medicine, Laboratory Medicine and Pathology, Mayo Clinic and Foundation, Rochester, MN.
authors.forename: Allan S
authors.initials: AS
authors.lastname: Jaffe
mesh_terms: D002318:Cardiovascular Diseases / Q000097:blood* / Q000401:mortality; D005260:Female; D006801:Humans; D057230:Limit of Detection; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011237:Predictive Value of Tests; D018570:Risk Assessment; D020107:Troponin T / Q000097:blood*
chemical_list: D010446:Peptide Fragments; D020107:Troponin T; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain