Abstract 18591: Identifying “At-Risk” Elderly Persons for New Onset Heart Failure: Implications for Assessment of High-Sensitive Troponin T.
Aims: In elderly persons, traditional risk factors have limited accuracy to predict cardiovascular (CV) outcomes. We hypothesized that utilizing a high sensitive troponin T (hsTnT) assay, as a measure of cardiac injury, would identify risk of new-onset heart failure (HF) in community-dwelling elderly.
Methods: hsTnT (lower limit of detection 3 pg/mL) levels were measured (Roche Elecsys 2010) in 4,221 elderly (>= 65 years) participants without prevalent HF from the Cardiovascular Health Study at study entry (1989-90, or 1992-93). HF hospitalizations were adjudicated for a median of 11.7 years. HF incidence per 100 person-years was determined per hsTnT quantile (with < 3 pg/mL [33%] grouped as a single category and other 7 quantiles as approximately deciles). Cox regression was used to estimate the risk of new-onset HF with adjustment for demographics, traditional CV risk factors, known coronary disease and NT-proBNP levels.
Results: The median age of the participants was 71 years, 59% were women, 16.2% were African-American, 17.6% were diabetic, and 59.5% were hypertensive. An inflexion point for increased incidence of HF was noted at the 7th quantile (>= 11.92 pg/mL, figure). For participants with undetectable hsTnT levels new onset HF occurred at 1.5/100 person-years versus 4.7 for those in the 7th quantile and 7.9 for those in the 8th quantile (figure) (>= 11.92 pg/mL of hsTnT levels were as follows: unadjusted HR 3.3 (2.9-3.7), adjusted HR 2.1(1.8-2.4), adjusted + NT-proBNP level HR 1.7(1.5-2.0).
Conclusion: A spectrum of hsTnT levels can be found in the elderly free of HF. Those with approximately the highest 20% of levels are at highest risk for new onset HF even after accounting for demographics, risk factors and natriuretic peptide levels. hsTnT levels may be an important adjunct for assessing risk of developing HF in the elderly.
- © 2010 by American Heart Association, Inc.