Prognostic Significance of High-Sensitivity Cardiac Troponin T Concentrations between the Limit of Blank and Limit of Detection in Community-Dwelling Adults: A Metaanalysis.
BACKGROUND
There is controversy regarding whether to report concentrations of high-sensitivity cardiac troponin T (hs-cTnT) to the limit of blank (LOB) (3 ng/L) or the limit of detection (LOD) (5 ng/L) of the assay in community-based cohorts. We hypothesized that hs-cTnT concentrations between the LOB and LOD would be associated with poorer cardiovascular outcomes compared to concentrations below the LOB.


METHODS
hs-cTnT was analyzed in a total of 10 723 participants from the Cardiovascular Health Study (CHS), Atherosclerosis Risk in Communities (ARIC) study, and Dallas Heart Study (DHS). Participants were divided into 2 groups, those with hs-cTnT concentrations below the limit of blank (LOB) (<3 ng/L) and those with hs-cTnT between the LOB and limit of detection (LOD) (3-4.99 ng/L). Cross-sectional associations with traditional cardiovascular risk factors and cardiac structural measurements, and longitudinal associations with long-term cardiovascular outcomes of incident heart failure and cardiovascular death, were determined.


RESULTS
Participants with hs-cTnT between the LOB and LOD for all 3 cohorts were older, more likely to be male, and have a higher burden of cardiovascular risk factors and structural pathology. A metaanalysis of the 3 cohorts showed participants with hs-cTnT between the LOB and LOD were at increased risk of new-onset heart failure (hazard ratio, 1.18; 95% CI, 1.02-1.38) and cardiovascular mortality (hazard ratio, 1.29; 95% CI, 1.06-1.57).


CONCLUSIONS
hs-cTnT concentrations between the LOB and LOD (3-4.99 ng/L) are associated with a higher prevalence of traditional risk factors, more cardiac pathology, and worse outcomes than concentrations below the LOB (<3 ng/L).
Department of Medicine, Division of Cardiovascular Medicine, University of Maryland School of Medicine, Baltimore, MD;
Ravi H
RH
Parikh
Department of Medicine, Division of Nephrology, University of Maryland School of Medicine, Baltimore, MD;
Stephen L
SL
Seliger
Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX;
James
J
de Lemos
Department of Medicine, Baylor College of Medicine, Center for Cardiovascular Disease Prevention, Methodist DeBakey Heart and Vascular Center, Michael E. DeBakey Veterans Affairs Hospital, Houston, TX;
Vijay
V
Nambi
Department of Pathology, University of Maryland School of Medicine, Baltimore, MD;
Robert
R
Christenson
Department of Internal Medicine, Department of Clinical Science, University of Texas Southwestern Medical Center, Dallas, TX;
Colby
C
Ayers
Department of Medicine, Baylor College of Medicine, Center for Cardiovascular Disease Prevention, Methodist DeBakey Heart and Vascular Center, Houston, TX;
Wensheng
W
Sun
Department of Medicine, Division of Cardiovascular Medicine, University of Maryland School of Medicine, Baltimore, MD;
John S
JS
Gottdiener
Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA.
Lewis H
LH
Kuller
Department of Medicine, Baylor College of Medicine, Center for Cardiovascular Disease Prevention, Methodist DeBakey Heart and Vascular Center, Houston, TX;
Christie
C
Ballantyne
Department of Medicine, Division of Cardiovascular Medicine, University of Maryland School of Medicine, Baltimore, MD; cdefilip@medicine.umaryland.edu.
Christopher R
CR
deFilippi
D000368:Aged; D050197:Atherosclerosis / Q000097:blood / Q000175:diagnosis*; D015415:Biomarkers / Q000097:blood; D003430:Cross-Sectional Studies; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000175:diagnosis*; D006801:Humans; D057187:Independent Living; D057230:Limit of Detection; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000175:diagnosis*; D011379:Prognosis; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D020107:Troponin T / Q000097:blood*
D015415:Biomarkers; D020107:Troponin T