High-sensitivity troponin T, NT-proBNP and glomerular filtration rate: A multimarker strategy for risk stratification in chronic heart failure.

Abstract

BACKGROUND:

In a recent individual patient data meta-analysis, high-sensitivity troponin T (hs-TnT) emerged as robust predictor of prognosis in stable chronic heart failure (HF). In the same population, we compared the relative predictive performances of hs-TnT, N-terminal fraction of pro-B-type natriuretic peptide (NT-proBNP), hs-C-reactive protein (hs-CRP), and estimated glomerular filtration rate (eGFR) for prognosis.

METHODS AND RESULTS:

9289 patients (66 ± 12 years, 77% men, 85% LVEF <40%, 60% ischemic HF) were evaluated over a 2.4-year median follow-up. Median eGFR was 58 mL/min/1.73 m2 (interquartile interval 46-70; n = 9220), hs-TnT 16 ng/L (8-20; n = 9289), NT-proBNP 1067 ng/L (433-2470; n = 8845), and hs-CRP 3.3 mg/L (1.4-7.8; n = 7083). In a model including all 3 biomarkers, only hs-TnT and NT-proBNP were independent predictors of all-cause and cardiovascular mortality and cardiovascular hospitalization. hs-TnT was a stronger predictor than NT-proBNP: for example, the risk for all-cause death increased by 54% per doubling of hs-TnT vs. 24% per doubling of NT-proBNP. eGFR showed independent prognostic value from both hs-TnT and NT-proBNP. The best hs-TnT and NT-proBNP cut-offs for the prediction of all-cause death increased progressively with declining renal function (eGFR ≥ 90: hs-TnT 13 ng/L and NT-proBNP 825 ng/L; eGFR < 30: hs-TnT 40 ng/L and NT-proBNP 4608 ng/L). Patient categorization according to these cut-offs effectively stratified patient prognosis across all eGFR classes.

CONCLUSIONS:

hs-TnT conveys independent prognostic information from NT-proBNP, while hs-CRP does not. Concomitant assessment of eGFR may further refine risk stratification. Patient classification according to hs-TnT and NT-proBNP cut-offs specific for the eGFR classes holds prognostic significance.

• Authors: Alberto Aimo, James L Januzzi Jr, Giuseppe Vergaro, Andrea Ripoli, Roberto Latini, Serge Masson, Michela Magnoli, Inder S Anand, Jay N Cohn, Luigi Tavazzi, Gianni Tognoni, Jørgen Gravning, Thor Ueland, Ståle H Nymo, Hans-Peter Brunner-La Rocca, Antoni Bayes-Genis, Josep Lupón, Rudolf A de Boer, Akiomi Yoshihisa, Yasuchika Takeishi, Michael Egstrup, Ida Gustafsson, Hanna K Gaggin, Kai M Eggers, Kurt Huber, Ioannis Tentzeris, W H Wilson Tang, Justin L Grodin, Claudio Passino, Michele Emdin
• Journal: International journal of cardiology (Int J Cardiol) Vol. 277 Pg. 166-172 (Feb 15 2019) ISSN: 1874-1754 [Electronic] Netherlands
• PMID: 30416028 (Publication Type: Journal Article, Meta-Analysis)
• Copyright: Copyright © 2018 Elsevier B.V. All rights reserved.

Chemical References

• Biomarkers
• Peptide Fragments
• Troponin T
• pro-brain natriuretic peptide (1-76)
• Natriuretic Peptide, Brain

Topics

• Aged
• Aged, 80 and over
• Biomarkers (blood)
• Chronic Disease
• Female
• Glomerular Filtration Rate (physiology)
• Heart Failure (blood, diagnosis, mortality)
• Humans
• Male
• Middle Aged
• Natriuretic Peptide, Brain (blood)
• Peptide Fragments (blood)
• Risk Assessment
• Troponin T (blood)