High-Sensitivity Troponin and Heart Failure With Preserved Ejection Fraction—Balancing P Values With Prior Knowledge and Common Sense—In reply

In Reply
We thank McEvoy for his interest in our article. Two important points are raised. First, there is a case made for repeated measurements of biomarkers. In particular, serial measures of high-sensitivity troponin might result in better risk prediction for future development of heart failure with preserved ejection fraction (HFpEF). We acknowledge that biomarker trajectories may indeed improve risk prediction over a single measurement. While serial measurements were not possible across 4 cohorts, the strength of our consortium was in the careful integration and harmonization of 12 biomarker measurements at a single point in time from 22 756 patients with 1474 cases of new-onset heart failure. This allowed the examination of biomarkers across a wide range of demographic backgrounds (eg, American vs European, young vs old, multiethnic vs white), lending further robustness to our findings via external validation extending beyond 1 study sample, as outlined by Ioannidis and Khoury and others.