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Coronary artery disease
Original research article
Clinical determinants of plasma cardiac biomarkers in patients with stable chest pain
  1. Rong Bing1,
  2. James Henderson1,
  3. Amanda Hunter1,
  4. Michelle C Williams1,2,
  5. Alastair J Moss1,
  6. Anoop S V Shah1,
  7. David A McAllister3,
  8. Marc R Dweck1,2,
  9. David E Newby1,2,
  10. Nicholas L Mills1,4,
  11. Philip D Adamson1,5
  1. 1 BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
  2. 2 Edinburgh Imaging, University of Edinburgh, Edinburgh, UK
  3. 3 Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
  4. 4 Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
  5. 5 Christchurch Heart Institute, University of Otago, Christchurch, New Zealand
  1. Correspondence to Dr Rong Bing, Centre for Cardiovascular Science, University of Edinburgh, Edinburgh EH8 9YL, UK; rongbing.rb{at}gmail.com

Abstract

Objective Troponin and B-type natriuretic peptide (BNP) concentrations are associated with cardiovascular risk in stable patients. Understanding their determinants and identifying modifiable clinical targets may improve outcomes. We aimed to establish clinical and cardiac determinants of these biomarkers.

Methods This was a prespecified substudy from the randomised Scottish Computed Tomography of the Heart trial, which enrolled patients 18–75 years with suspected stable angina between 2010 and 2014 (NCT01149590). We included patients from six centres in whom high-sensitivity troponin I and BNP were measured (Singulex Erenna). Patients with troponin >99th centile upper reference limit (10.2 ng/L) or BNP ≥400 ng/L were excluded to avoid inclusion of patients with myocardial injury or heart failure. Multivariable linear regression models were constructed with troponin and BNP as dependent variables.

Results In total, 885 patients were included; 881 (99%) and 847 (96%) had troponin and BNP concentrations above the limit of detection, respectively. Participants had a slight male preponderance (n=513; 56.1%), and the median age was 59.0 (IQR 51.0–65.0) years. The median troponin and BNP concentrations were 1.4 (IQR 0.90–2.1) ng/L and 29.1 (IQR 14.0–54.0) ng/L, respectively. Age and atherosclerotic burden were independent predictors of both biomarkers. Male sex, left ventricular mass and systolic blood pressure were independent predictors of increased troponin. In contrast, female sex and left ventricular volume were independent predictors of increased BNP.

Conclusions Troponin and BNP are associated with coronary atherosclerosis but have important sex differences and distinct and contrasting associations with CT-determined left ventricular mass and volume.

Clinical Trial registration NCT01149590; Post-results.

  • computed tomography coronary angiography
  • troponin
  • B-type natriuretic peptide
  • cardiac biomarkers
  • coronary artery disease

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

https://doi.org/10.1136/heartjnl-2019-314892

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    Footnotes

    • Contributors RB and PDA drafted the manuscript. JH, AH, MCW and AM contributed to image analysis and data collection. RB, ASVS, DM and PDA contributed to data analysis. MRD, DEN and NLM contributed to the study conceptualisation, methodology, oversight and funding acquisition. All authors contributed to the final manuscript.

    • Funding The Chief Scientist Office of the Scottish Government (CZH/4/588) funded the SCOT-HEART trial with supplementary support from the British Heart Foundation (RE/13/3/30183), Edinburgh and Lothians Health Foundation Trust, and the Heart Diseases Research Fund. DEN (CH/09/002, RE/18/5/34216), NLM (FS/16/14/32023) and MRD (FS/14/78/31020) are supported by the British Heart Foundation. DEN is also the recipient of a Wellcome Trust Senior Investigator Award (WT103782AIA). MCW is supported by the Chief Scientist Office of the Scottish Government Health and Social Care Directorates (PCL/17/04). DM is supported by an Intermediate Clinical Fellowship and Beit Fellowship from the Wellcome Trust (201492/Z/16/Z).

    • Competing interests None declared.

    • Ethics approval Ethical approval was provided by the South East Scotland Research Ethics Committee 02, Edinburgh, UK (10/S1102/43).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Patient consent for publication Not required.