Abstract 14209: High Sensitivity Troponin T and NT-proBNP in Heart Failure Risk Prediction: an Analysis from the Atherosclerosis Risk in Communities (ARIC) Sudy

Abstract

Objectives: We evaluated whether scores incorporating troponin T (TnT), measured with a high sensitivity assay and NT-pro B type natriuretic peptide (NTproBNP) improve heart failure (HF) risk prediction in the ARIC study.

Methods: Participants from the ARIC study (1997-99) without prevalent HF were included. Cox proportional hazards were used to describe various HF prediction models. Model 1 was a recently published clinical ARIC HF model which includes age, race, gender, systolic blood pressure, antihypertensive medication use, current smoking, diabetes, body mass index, prevalent coronary heart disease and heart rate. Model 2 added TnT and NTproBNP to model 1 while model 3 was a simplified model (biomarker model) that included age, race, gender, TnT and NTproBNP. Categorized TnT values (table) and log transformed NT-proBNP were used. Improvements in area under the receiver operator characteristics curve (AUC), net reclassification index (NRI), integrated discrimination index (IDI) and model fit were described.

Results: The mean age of our study population (n=10,109) was 62.7 years (44% males, 79% white, 45% hypertension and 16% diabetes). Troponin T was detectable in ~67% of the population. Over a mean follow up of 10.4 years there were 982 hospitalizations with HF. For each model ~65-75% of the incident HF events occurred in the highest 3 deciles of estimated risk. Adding TnT and NTproBNP to model 1 significantly improved HF prediction and was the best model in our analysis (Table). The simplified biomarker model, however, performed as well as model 1 (Table).

Conclusion: Adding TnT and NTproBNP significantly improved HF risk prediction in the ARIC study. A simple model that included only age, race, gender, TnT and NTproBNP which can be implemented with greater ease performed as well as a clinical ARIC HF model. Measuring TnT with a high sensitivity assay and NTproBNP, is an attractive strategy for heart failure risk prediction among middle to older age adults.