03186nas a2200481 4500008004100000022001400041245017800055210006900233260001300302300001200315490000700327520177800334653000902112653002002121653001502141653002802156653001102184653001802195653001102213653002302224653002302247653002502270653000902295653001602304653002602320653001402346653002002360653001702380653001602397653001502413100002002428700002402448700002002472700001702492700002402509700001702533700001802550700002402568700002102592700002502613700003002638856003602668 2015 eng d a1530-856100aPrognostic Significance of High-Sensitivity Cardiac Troponin T Concentrations between the Limit of Blank and Limit of Detection in Community-Dwelling Adults: A Metaanalysis.0 aPrognostic Significance of HighSensitivity Cardiac Troponin T Co c2015 Dec a1524-310 v613 a

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).

10aAged10aAtherosclerosis10aBiomarkers10aCross-Sectional Studies10aFemale10aHeart Failure10aHumans10aIndependent Living10aLimit of Detection10aLongitudinal Studies10aMale10aMiddle Aged10aMyocardial Infarction10aPrognosis10aRisk Assessment10aRisk Factors10aSex Factors10aTroponin T1 aParikh, Ravi, H1 aSeliger, Stephen, L1 ade Lemos, James1 aNambi, Vijay1 aChristenson, Robert1 aAyers, Colby1 aSun, Wensheng1 aGottdiener, John, S1 aKuller, Lewis, H1 aBallantyne, Christie1 adeFilippi, Christopher, R uhttps://chs-nhlbi.org/node/687802516nas a2200193 4500008004100000022001400041245011900055210006900174260001300243490000600256520188200262100002002144700002402164700002402188700002402212700002002236700003002256856003602286 2016 eng d a2047-998000aSoluble ST2 for Prediction of Heart Failure and Cardiovascular Death in an Elderly, Community-Dwelling Population.0 aSoluble ST2 for Prediction of Heart Failure and Cardiovascular D c2016 Aug0 v53 a

BACKGROUND: Soluble ST2 (sST2), a marker of myocyte stretch and fibrosis, has prognostic value in many cardiovascular diseases. We hypothesized that sST2 levels are associated with incident heart failure (HF), including subtypes of preserved (HFpEF) and reduced (HFrEF) ejection fraction, and cardiovascular death.

METHODS AND RESULTS: Baseline serum sST2 was measured in 3915 older, community-dwelling subjects from the Cardiovascular Health Study without prevalent HF. sST2 levels were associated with older age, male sex, black race, traditional cardiovascular risk factors, other biomarkers of inflammation, cardiac stretch, myocardial injury, and fibrosis, and abnormal echocardiographic parameters. In longitudinal analysis, greater sST2 was associated with a higher risk of incident HF and cardiovascular death; however, in multivariate models adjusting for other cardiac risk factors and the cardiac-specific biomarker, N-terminal pro-type B natriuretic peptide, these associations were attenuated. In these models, an sST2 level above the US Food and Drug Administration-approved cut-off value (>35 ng/mL) was significantly associated with incident HF (hazard ratio [HR], 1.20; 95% CI, 1.02-1.43) and cardiovascular death (HR, 1.21; 95% CI, 1.02-1.44), and greater sST2 was continuously associated with cardiovascular death (per 1-ln increment: HR, 1.24; 95% CI, 1.02-1.50). sST2 was not associated with the HF subtypes of HFpEF and HFrEF in adjusted analysis. Addition of sST2 to existing risk models of HF and cardiovascular death modestly improved discrimination and reclassification into a higher risk.

CONCLUSIONS: The predictive value of sST2 for HF of all subtypes and cardiovascular death is modest in an elderly population despite strong cross-sectional associations with risk factors and underlying cardiac pathology.

1 aParikh, Ravi, H1 aSeliger, Stephen, L1 aChristenson, Robert1 aGottdiener, John, S1 aPsaty, Bruce, M1 adeFilippi, Christopher, R uhttps://chs-nhlbi.org/node/7130