Addition of highly sensitive troponin T and N-terminal pro-b-type natriuretic peptide to electrocardiography for detection of left ventricular hypertrophy

Results from the dallas heart study

Abelardo A. Martinez-Rumayor, James A de Lemos, Anand K Rohatgi, Colby R. Ayers, Tiffany M. Powell-Wiley, Susan G. Lakoski, Jarett D Berry, Amit Khera, Sandeep R Das

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Left ventricular hypertrophy (LVH) is an independent, modifiable risk factor for cardiovascular disease. However, current screening strategies are limited. In 2478 participants without clinical disease from the Dallas Heart Study, we evaluated a multimarker screening strategy that complements electrocardiographic (ECG) criteria for LVH with 2 biomarkers, amino-terminal pro-B-type natriuretic peptide and highly sensitive cardiac troponin T. An integer LVH risk score from 0 to 3 was determined as the sum of the following: (1) LVH by Sokolow-Lyon ECG; (2) amino-terminal pro-B-type natriuretic peptide in the highest sex-specific quartile; and (3) detectable cardiac troponin T. Cardiac magnetic resonance imaging-determined LVH served as the primary outcome. The probability of LVH increased from 2% with an LVH risk score of 0 to 50% with a score of 3 (P<0.001). Sokolow-Lyon ECG afforded low sensitivity (26% [95% confidence interval {CI}, 17-32%]) and high specificity (96% [95% CI, 95-97%]), whereas a risk score ≥2 offered higher sensitivity (44% [95% CI, 34-51%]) with good specificity (90% [95% CI, 89-93%]) and a score threshold of 1 offered reasonable sensitivity (76% [95% CI, 67-83%]) with lower specificity (55% [95% CI, 53-61%]) and high negative predictive value (98% [95% CI, 97-98%]). Area under the receiver operator characteristic curve improved from 0.760 (95% CI, 0.716-0.804) for ECG alone to 0.798 (95% CI, 0.754-0.842) for the LVH risk score (P=0.0012), consistent with modest improvement in overall discrimination. Better screening for LVH may be achieved by combining simple tests, which collectively provide additional information compared with ECG alone. Further studies are needed to evaluate the impact and cost-effectiveness of a multimarker screening strategy.

Original languageEnglish (US)
Pages (from-to)105-111
Number of pages7
JournalHypertension
Volume61
Issue number1
DOIs
StatePublished - Jan 2013

Fingerprint

Natriuretic Peptides
Troponin T
Left Ventricular Hypertrophy
Electrocardiography
Confidence Intervals
Brain Natriuretic Peptide
Cost-Benefit Analysis
Heart Diseases
Cardiovascular Diseases
Biomarkers
Magnetic Resonance Imaging

Keywords

  • amino-terminal B-type natriuretic peptide
  • diagnostic performance
  • electrocardiographic Sokolow-Lyon criteria
  • highly sensitive troponin T
  • left ventricular hypertrophy screening

ASJC Scopus subject areas

  • Internal Medicine

Cite this

@article{b87bb5510f9a4b5a81aff5ca3e8d0edd,
title = "Addition of highly sensitive troponin T and N-terminal pro-b-type natriuretic peptide to electrocardiography for detection of left ventricular hypertrophy: Results from the dallas heart study",
abstract = "Left ventricular hypertrophy (LVH) is an independent, modifiable risk factor for cardiovascular disease. However, current screening strategies are limited. In 2478 participants without clinical disease from the Dallas Heart Study, we evaluated a multimarker screening strategy that complements electrocardiographic (ECG) criteria for LVH with 2 biomarkers, amino-terminal pro-B-type natriuretic peptide and highly sensitive cardiac troponin T. An integer LVH risk score from 0 to 3 was determined as the sum of the following: (1) LVH by Sokolow-Lyon ECG; (2) amino-terminal pro-B-type natriuretic peptide in the highest sex-specific quartile; and (3) detectable cardiac troponin T. Cardiac magnetic resonance imaging-determined LVH served as the primary outcome. The probability of LVH increased from 2{\%} with an LVH risk score of 0 to 50{\%} with a score of 3 (P<0.001). Sokolow-Lyon ECG afforded low sensitivity (26{\%} [95{\%} confidence interval {CI}, 17-32{\%}]) and high specificity (96{\%} [95{\%} CI, 95-97{\%}]), whereas a risk score ≥2 offered higher sensitivity (44{\%} [95{\%} CI, 34-51{\%}]) with good specificity (90{\%} [95{\%} CI, 89-93{\%}]) and a score threshold of 1 offered reasonable sensitivity (76{\%} [95{\%} CI, 67-83{\%}]) with lower specificity (55{\%} [95{\%} CI, 53-61{\%}]) and high negative predictive value (98{\%} [95{\%} CI, 97-98{\%}]). Area under the receiver operator characteristic curve improved from 0.760 (95{\%} CI, 0.716-0.804) for ECG alone to 0.798 (95{\%} CI, 0.754-0.842) for the LVH risk score (P=0.0012), consistent with modest improvement in overall discrimination. Better screening for LVH may be achieved by combining simple tests, which collectively provide additional information compared with ECG alone. Further studies are needed to evaluate the impact and cost-effectiveness of a multimarker screening strategy.",
keywords = "amino-terminal B-type natriuretic peptide, diagnostic performance, electrocardiographic Sokolow-Lyon criteria, highly sensitive troponin T, left ventricular hypertrophy screening",
author = "Martinez-Rumayor, {Abelardo A.} and {de Lemos}, {James A} and Rohatgi, {Anand K} and Ayers, {Colby R.} and Powell-Wiley, {Tiffany M.} and Lakoski, {Susan G.} and Berry, {Jarett D} and Amit Khera and Das, {Sandeep R}",
year = "2013",
month = "1",
doi = "10.1161/HYPERTENSIONAHA.112.195289",
language = "English (US)",
volume = "61",
pages = "105--111",
journal = "Hypertension",
issn = "0194-911X",
publisher = "Lippincott Williams and Wilkins",
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TY - JOUR

T1 - Addition of highly sensitive troponin T and N-terminal pro-b-type natriuretic peptide to electrocardiography for detection of left ventricular hypertrophy

T2 - Results from the dallas heart study

AU - Martinez-Rumayor, Abelardo A.

AU - de Lemos, James A

AU - Rohatgi, Anand K

AU - Ayers, Colby R.

AU - Powell-Wiley, Tiffany M.

AU - Lakoski, Susan G.

AU - Berry, Jarett D

AU - Khera, Amit

AU - Das, Sandeep R

PY - 2013/1

Y1 - 2013/1

N2 - Left ventricular hypertrophy (LVH) is an independent, modifiable risk factor for cardiovascular disease. However, current screening strategies are limited. In 2478 participants without clinical disease from the Dallas Heart Study, we evaluated a multimarker screening strategy that complements electrocardiographic (ECG) criteria for LVH with 2 biomarkers, amino-terminal pro-B-type natriuretic peptide and highly sensitive cardiac troponin T. An integer LVH risk score from 0 to 3 was determined as the sum of the following: (1) LVH by Sokolow-Lyon ECG; (2) amino-terminal pro-B-type natriuretic peptide in the highest sex-specific quartile; and (3) detectable cardiac troponin T. Cardiac magnetic resonance imaging-determined LVH served as the primary outcome. The probability of LVH increased from 2% with an LVH risk score of 0 to 50% with a score of 3 (P<0.001). Sokolow-Lyon ECG afforded low sensitivity (26% [95% confidence interval {CI}, 17-32%]) and high specificity (96% [95% CI, 95-97%]), whereas a risk score ≥2 offered higher sensitivity (44% [95% CI, 34-51%]) with good specificity (90% [95% CI, 89-93%]) and a score threshold of 1 offered reasonable sensitivity (76% [95% CI, 67-83%]) with lower specificity (55% [95% CI, 53-61%]) and high negative predictive value (98% [95% CI, 97-98%]). Area under the receiver operator characteristic curve improved from 0.760 (95% CI, 0.716-0.804) for ECG alone to 0.798 (95% CI, 0.754-0.842) for the LVH risk score (P=0.0012), consistent with modest improvement in overall discrimination. Better screening for LVH may be achieved by combining simple tests, which collectively provide additional information compared with ECG alone. Further studies are needed to evaluate the impact and cost-effectiveness of a multimarker screening strategy.

AB - Left ventricular hypertrophy (LVH) is an independent, modifiable risk factor for cardiovascular disease. However, current screening strategies are limited. In 2478 participants without clinical disease from the Dallas Heart Study, we evaluated a multimarker screening strategy that complements electrocardiographic (ECG) criteria for LVH with 2 biomarkers, amino-terminal pro-B-type natriuretic peptide and highly sensitive cardiac troponin T. An integer LVH risk score from 0 to 3 was determined as the sum of the following: (1) LVH by Sokolow-Lyon ECG; (2) amino-terminal pro-B-type natriuretic peptide in the highest sex-specific quartile; and (3) detectable cardiac troponin T. Cardiac magnetic resonance imaging-determined LVH served as the primary outcome. The probability of LVH increased from 2% with an LVH risk score of 0 to 50% with a score of 3 (P<0.001). Sokolow-Lyon ECG afforded low sensitivity (26% [95% confidence interval {CI}, 17-32%]) and high specificity (96% [95% CI, 95-97%]), whereas a risk score ≥2 offered higher sensitivity (44% [95% CI, 34-51%]) with good specificity (90% [95% CI, 89-93%]) and a score threshold of 1 offered reasonable sensitivity (76% [95% CI, 67-83%]) with lower specificity (55% [95% CI, 53-61%]) and high negative predictive value (98% [95% CI, 97-98%]). Area under the receiver operator characteristic curve improved from 0.760 (95% CI, 0.716-0.804) for ECG alone to 0.798 (95% CI, 0.754-0.842) for the LVH risk score (P=0.0012), consistent with modest improvement in overall discrimination. Better screening for LVH may be achieved by combining simple tests, which collectively provide additional information compared with ECG alone. Further studies are needed to evaluate the impact and cost-effectiveness of a multimarker screening strategy.

KW - amino-terminal B-type natriuretic peptide

KW - diagnostic performance

KW - electrocardiographic Sokolow-Lyon criteria

KW - highly sensitive troponin T

KW - left ventricular hypertrophy screening

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