Troponin T and N-Terminal Pro-B-Type Natriuretic Peptide: A Biomarker Approach to Predict Heart Failure Risk-The Atherosclerosis Risk in Communities Study

BACKGROUND: Among the various cardiovascular diseases, heart failure (HF) is projected to have the largest increases in incidence over the coming decades; therefore, improving HF prediction is of significant value. Weevaluated whether cardiac troponin T (cTnT) measured with a high- sensitivity assay and N- terminal pro- B- type natriuretic peptide (NT- proBNP), biomarkers strongly associated with incident HF, improve HF risk prediction in the Atherosclerosis Risk in Communities (ARIC) study. METHODS: Using sex- specific models, we added cTnT and NT- proBNP to age and race (" laboratory report" model) and to the ARIC HF model (includes age, race, systolic blood pressure, antihypertensive medication use, current/ former smoking, diabetes, body mass index, prevalent coronary heart disease, and heart rate) in 9868 participants without prevalent HF; area under the receiver operating characteristic curve (AUC), integrated discrimination improvement, net reclassification improvement (NRI), and model fit were described. RESULTS: Over a mean follow- up of 10.4 years, 970 participants developed incident HF. Adding cTnT and NT- proBNP to the ARIC HF model significantly improved all statistical parameters (AUCs increased by 0.040 and 0.057; the continuous NRIs were 50.7% and 54.7% in women and men, respectively). Interestingly, the simpler laboratory report model was statistically no different than the ARIC HF model. CONCLUSIONS: cTnT and NT- proBNP have significant value in HF risk prediction. A simple sex- specific model that includes age, race, cTnT, and NT- proBNP (which can be incorporated in a laboratory report) provides a good model, whereas adding cTnT and NTproBNP to clinical characteristics results in an excellent HF prediction model. c 2013 American Association for Clinical Chemistry