Department of Laboratory Medicine, University Hospital of North Norway, Tromsø, 9038, Norway.
Department of Community Medicine, UiT the Arctic University of Norway, Tromsø, Norway.
ESC Heart Fail. 2022 Jun;9(3):1954-1962. doi: 10.1002/ehf2.13906. Epub 2022 Mar 23.
The aim of this study was to establish age-specific and sex-specific cut-off values for N-terminal pro-brain natriuretic peptide (NT-proBNP) and high-sensitivity troponin T (hs-troponin T) in healthy subjects and assess cardiac biomarkers as screening tools for subclinical heart failure (HF) in a general population.
Altogether, 1936 participants were randomly selected from the general population Tromsø 7 study in Northern Norway. Diagnostic accuracy (sensitivity, specificity, and negative and positive predictive value) of cardiac markers for echocardiographically defined subclinical HF was evaluated. The receiver-operating characteristic analysis showed that areas under the curve were relatively low (under 0.75) for both NT-proBNP and hs-troponin T, suggesting that the diagnostic accuracy of these biomarkers for subclinical HF was not excellent, especially for mild forms of HF and younger age group 40-49 years. Sex-specific and age-specific cut-offs for hs-troponin T (99th percentiles) and NT-proBNP (97.5th percentiles) were established in healthy subjects from the same general population. The sex-specific and age-specific cut-offs for NT-proBNP had higher specificity for subclinical HF compared with the previously established single cut-off 125 pg/mL. Age-specific cut-off for hs-troponin T (18 ng/L) for men ≥60 years had also higher specificity than the single cut-off 14 ng/L. These cut-offs had high specificity, but low sensitivity, that makes hs-troponin T and NT-proBNP good biomarkers to rule in HF in case of a positive test, but not good enough to rule out all unrecognized HF due to false negative results.
N-terminal pro-brain natriuretic peptide and hs-troponin T are suboptimal screening tools for subclinical HF in a general population due to low sensitivity.
本研究旨在为健康人群建立年龄和性别特异性的 N 末端脑利钠肽前体（NT-proBNP）和高敏肌钙蛋白 T（hs-troponin T）截断值，并评估心脏生物标志物作为一般人群亚临床心力衰竭（HF）的筛查工具。
本研究共从挪威特罗姆瑟 7 研究中随机选择了 1936 名参与者。评估了心脏标志物对超声心动图定义的亚临床 HF 的诊断准确性（敏感性、特异性、阴性和阳性预测值）。受试者工作特征曲线分析显示，NT-proBNP 和 hs-troponin T 的曲线下面积均相对较低（<0.75），表明这些生物标志物对亚临床 HF 的诊断准确性并不优异，尤其是对轻度 HF 和年龄在 40-49 岁的年轻人群。在来自同一人群的健康人群中建立了 hs-troponin T（99 百分位数）和 NT-proBNP（97.5 百分位数）的性别特异性和年龄特异性截断值。与之前建立的 125pg/ml 单一截断值相比，NT-proBNP 的性别特异性和年龄特异性截断值对亚临床 HF 具有更高的特异性。年龄特异性 hs-troponin T（男性≥60 岁时为 18ng/L）截断值的特异性也高于 14ng/L 的单一截断值。这些截断值具有较高的特异性，但敏感性较低，这使得 hs-troponin T 和 NT-proBNP 成为阳性试验时诊断 HF 的良好生物标志物，但不足以排除所有因假阴性结果而未被识别的 HF。
由于敏感性低，NT-proBNP 和 hs-troponin T 作为一般人群亚临床 HF 的筛查工具并不理想。
