TY - JOUR
T1 - Association between Circulating Troponin Concentrations, Left Ventricular Systolic and Diastolic Functions, and Incident Heart Failure in Older Adults
AU - Myhre, Peder L.
AU - Claggett, Brian
AU - Ballantyne, Christie M.
AU - Selvin, Elizabeth
AU - Røsjø, Helge
AU - Omland, Torbjørn
AU - Solomon, Scott D.
AU - Skali, Hicham
AU - Shah, Amil M.
N1 - Funding Information:
AoBiome, Janssen, Cardiac Dimensions, and Tenaya outside the submitted work. Dr Shah reported receiving research support from Novartis; consulting fees from Philips Ultrasound and Bellerophon; and grants from National Institutes of Health/National Heart, Lung, and Blood Institute during the conduct of the study. No other disclosures were reported. Funding/Support: The Atherosclerosis Risk in Communities Study is funded in whole or in part by contracts HHSN268201700001I, HHSN268201700002I, HHSN268201700003I, HHSN268201700005I, and HHSN268201700004I from the National Heart, Lung, and Blood Institute (NHLBI), the National Institutes of Health (NIH), and the US Department of Health and Human Services. This study was supported by grants K08HL116792, R01HL135008, and R01HL143224 from the NHLBI (Dr Shah); the Watkins Discovery Award from the Brigham and Women’s Heart and Vascular Center (Dr Shah); grants K24DK106414 and R01DK089174 from the NIH/National Institute of Diabetes and Digestive and Kidney Diseases (Dr Selvin); grant R01HL134320 from the NIH/NHLBI (Drs Ballantyne and Selvin); and research grant from the South-Eastern Norway Regional Health Authority, the Norwegian Medical Association, and the Unger Vetlesen Medical Fund (Dr Myhre). The reagents for the hs-cTnT assays were donated by Roche Diagnostics.
Publisher Copyright:
© 2019 American Medical Association. All rights reserved.
PY - 2019/10
Y1 - 2019/10
N2 - Importance: Cardiac troponin is associated with incident heart failure and greater left ventricular (LV) mass. Its association with LV systolic and diastolic functions is unclear. Objectives: To define the association of high-sensitivity cardiac troponin T (hs-cTnT) with LV systolic and diastolic functions in the general population, and to evaluate the extent to which that association accounts for the correlation between hs-cTnT concentration and incident heart failure overall, heart failure with preserved LV ejection fraction (LVEF; HFpEF), and heart failure with LVEF less than 50%. Design, Setting, and Participants: This analysis of the Atherosclerosis Risk in Communities (ARIC) Study, an ongoing epidemiologic cohort study in US communities, included participants without cardiovascular disease (n = 4111). Available hs-cTnT measurements for participants who attended ARIC Study visits 2 (1990 to 1992), 4 (1996 to 1998), and 5 (2011 to 2013) were assessed cross-sectionally against echocardiographic measurements taken at visit 5 and against incident health failure after visit 5. Changes in hs-cTnT concentrations from visits 2 and 4 were also examined. Data analyses were performed from August 2017 to July 2018. Main Outcomes and Measures: Cardiac structure and function by echocardiography at visit 5, and incident heart failure during a median 4 1/2 years follow-up after visit 5. Results: Of the 6538 eligible participants, 4111 (62.9%) without cardiovascular disease were included. Among these participants, 2586 (62.9%) were female, and the mean (SD) age was 75 (5) years. Median (interquartile range) hs-cTnT concentration at visit 5 was 9 (7-14) ng/L and was detectable in 3946 participants (96.0%). After adjustment for demographic and clinical covariates, higher hs-cTnT levels were associated with greater LV mass index (adjusted mean [SE] for group 1: 33.8 [0.5] vs group 5: 40.1 [0.4]; P for trend <.001) and with worse diastolic function, including lower tissue Doppler imaging e' (6.00 [0.07] vs 5.54 [0.06]; P for trend <.001), higher E/e' ratio (11.4 [0.2] vs 12.9 [0.1]; P for trend <.001), and greater left atrial volume index (23.4 [0.4] vs 26.4 [0.3]; P for trend <.001), independent of LV mass index; hs-cTnT level was not associated with measures of LV systolic function. Accounting for diastolic function attenuated the association of hs-cTnT concentration with incident HFpEF by 41% and the association with combined heart failure with midrange and reduced ejection fraction combined (LVEF <50) by 17%. Elevated hs-cTnT concentration and diastolic dysfunction were additive risk factors for incident heart failure. For any value of late-life hs-cTnT levels, longer duration of detectable hs-cTnT from midlife to late life was associated with greater LV mass in late life but not with worse LV systolic or diastolic function. Conclusions and Relevance: This study shows that higher hs-cTnT concentrations were associated with worse diastolic function, irrespective of LV mass, but not with systolic function; these findings suggest that high levels of hs-cTnT may serve as an early marker of subclinical alterations in diastolic function that may lead to a predisposition to heart failure.
AB - Importance: Cardiac troponin is associated with incident heart failure and greater left ventricular (LV) mass. Its association with LV systolic and diastolic functions is unclear. Objectives: To define the association of high-sensitivity cardiac troponin T (hs-cTnT) with LV systolic and diastolic functions in the general population, and to evaluate the extent to which that association accounts for the correlation between hs-cTnT concentration and incident heart failure overall, heart failure with preserved LV ejection fraction (LVEF; HFpEF), and heart failure with LVEF less than 50%. Design, Setting, and Participants: This analysis of the Atherosclerosis Risk in Communities (ARIC) Study, an ongoing epidemiologic cohort study in US communities, included participants without cardiovascular disease (n = 4111). Available hs-cTnT measurements for participants who attended ARIC Study visits 2 (1990 to 1992), 4 (1996 to 1998), and 5 (2011 to 2013) were assessed cross-sectionally against echocardiographic measurements taken at visit 5 and against incident health failure after visit 5. Changes in hs-cTnT concentrations from visits 2 and 4 were also examined. Data analyses were performed from August 2017 to July 2018. Main Outcomes and Measures: Cardiac structure and function by echocardiography at visit 5, and incident heart failure during a median 4 1/2 years follow-up after visit 5. Results: Of the 6538 eligible participants, 4111 (62.9%) without cardiovascular disease were included. Among these participants, 2586 (62.9%) were female, and the mean (SD) age was 75 (5) years. Median (interquartile range) hs-cTnT concentration at visit 5 was 9 (7-14) ng/L and was detectable in 3946 participants (96.0%). After adjustment for demographic and clinical covariates, higher hs-cTnT levels were associated with greater LV mass index (adjusted mean [SE] for group 1: 33.8 [0.5] vs group 5: 40.1 [0.4]; P for trend <.001) and with worse diastolic function, including lower tissue Doppler imaging e' (6.00 [0.07] vs 5.54 [0.06]; P for trend <.001), higher E/e' ratio (11.4 [0.2] vs 12.9 [0.1]; P for trend <.001), and greater left atrial volume index (23.4 [0.4] vs 26.4 [0.3]; P for trend <.001), independent of LV mass index; hs-cTnT level was not associated with measures of LV systolic function. Accounting for diastolic function attenuated the association of hs-cTnT concentration with incident HFpEF by 41% and the association with combined heart failure with midrange and reduced ejection fraction combined (LVEF <50) by 17%. Elevated hs-cTnT concentration and diastolic dysfunction were additive risk factors for incident heart failure. For any value of late-life hs-cTnT levels, longer duration of detectable hs-cTnT from midlife to late life was associated with greater LV mass in late life but not with worse LV systolic or diastolic function. Conclusions and Relevance: This study shows that higher hs-cTnT concentrations were associated with worse diastolic function, irrespective of LV mass, but not with systolic function; these findings suggest that high levels of hs-cTnT may serve as an early marker of subclinical alterations in diastolic function that may lead to a predisposition to heart failure.
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U2 - 10.1001/jamacardio.2019.3113
DO - 10.1001/jamacardio.2019.3113
M3 - Article
C2 - 31483438
AN - SCOPUS:85072198402
SN - 2380-6583
VL - 4
SP - 997
EP - 1006
JO - JAMA cardiology
JF - JAMA cardiology
IS - 10
ER -