Preclinical screening for cardiovascular disease with high-sensitivity cardiac troponins: ready, set, go?

Figures

• 

  Figure 1. A potential screening strategy is identification of ambulatory individuals with stage A or B heart failure (risk factors or asymptomatic structural findings such as left ventricular hypertrophy) with early stages of hypertension; when these individuals are identified with elevated hs-cTnI or T levels and treated to low systolic blood pressure targets, they may experience a lower incidence of symptomatic heart failure and other adverse cardiovascular events in the next 5–10 years. This scenario requires prospective validation.

• 

  Figure 2. The 10-year number needed to treat to prevent an incident composite CV event, or HF (right), across 2017 ACC/AHA BP guideline–recommended treatment groups stratified by hs-cTnT [Adapted from Pandey et al. (12)]. The dotted red line represents the 10-year NNT to prevent an incident composite CV event (left) and HF (right) for the group with stage 2 HTN (BP≥160/100 mmHg). Definitions: Elevated BP, 120–129/<80 mm Hg; stage 1 HTN, 130–139/80 to 89 mm Hg; stage 1 high-risk HTN was defined by the presence of any of the following: PCE-estimated 10-year ASCVD risk ≥10%, diabetes mellitus, estimated GFR <60 ml/min/1.73 m2, or age ≥65 years with systolic BP ≥130 mmHg; in the absence of all of these risk factors, individuals with stage 1 HTN were classified as low risk. An hs-cTnT≥6 ng/L is considered elevated. NNT, number needed to treat; CV, cardiovascular; HF, heart failure; BP, blood pressure; HTN, hypertension; hs-cTnT, high-sensitivity cardiac troponin T; ASCVD, atherosclerotic cardiovascular disease; GFR, glomerular filtration rate; PCE, pooled cohort equation. Adapted with permission from “Prevalence of elevated hs-cTnT or NT-proBNP across 2017 ACC/AHA BP guideline recommended…