High-Sensitivity Cardiac Troponin and New-Onset Heart Failure: A Systematic Review and Meta-Analysis of 67,063 Patients With 4,165 Incident Heart Failure Events.
Evans, Jonathan DW
Pettit, Stephen J
JACC. Heart failure
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Evans, J. D., Dobbin, S. J., Pettit, S. J., Di Angelantonio, E., & Willeit, P. (2018). High-Sensitivity Cardiac Troponin and New-Onset Heart Failure: A Systematic Review and Meta-Analysis of 67,063 Patients With 4,165 Incident Heart Failure Events.. JACC. Heart failure, 6 (3), 187-197. https://doi.org/10.1016/j.jchf.2017.11.003
Background: Identification of individuals at high risk of heart failure and early risk factor modification with medications such as ACE inhibitors may delay the onset of heart failure. High-sensitivity cardiac troponin (hs-cTn) has been suggested as a prognostic marker for the incidence of first-ever heart failure in asymptomatic individuals. Methods: Pubmed, Embase and Web of Science were systematically searched for prospective cohort studies published before January 2017 that reported associations between hs-cTn and incident heart failure in individuals without baseline heart failure. Study-specific multivariable adjusted hazard ratios were pooled using random-effects meta-analysis. Results: Data were collated from sixteen studies with a total of 67,063 individuals and 4,165 incident heart failure events. Average age was 57 years and 47% were female. Study quality was high (Newcastle-Ottawa score: 8.2/9). In a comparison of participants in the top third with those in the bottom third of baseline values of hs-cTn, the pooled multivariable adjusted hazard ratio for incident heart failure was 2.09 (95% CI 1.76-2.48, p<0.001). Between-study heterogeneity was high with an I2 of 80%. Hazard ratios were similar in men and women (2.29 [1.64-3.21] vs 2.18 [1.68-2.81]), with hs-cTnI and hs-cTnT (2.09 [1.53-2.85] vs 2.11 [1.69-2.63]) and across other study-level characteristics. Further adjustment for B-type natriuretic peptides yielded a similar hazard ratio of 2.08 (1.64-2.65). Assay of hs-cTn in addition to conventional risk factors provided improvements in the c-index of 1-3%. Conclusions: Available prospective studies indicate a strong association of hs-cTn with the risk of first-ever heart failure and significant improvements in heart failure prediction.
Humans, Myocardial Infarction, Troponin, Aged, Middle Aged, Female, Male, Heart Failure, Biomarkers
British Heart Foundation (RG/08/014/24067)
External DOI: https://doi.org/10.1016/j.jchf.2017.11.003
This record's URL: https://www.repository.cam.ac.uk/handle/1810/271639