Prognostic Implications of N-Terminal Pro-B-Type Natriuretic Peptide and High-Sensitivity Cardiac Troponin T in EMPEROR-Preserved.

Abstract

BACKGROUND:

N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high-sensitivity cardiac troponin T (hs-cTnT) are associated with disease severity and outcomes among patients with heart failure (HF) with preserved ejection fraction.

OBJECTIVES:

The authors evaluated associations between both biomarkers and clinical outcomes in the EMPEROR-Preserved (Empagliflozin Outcome Trial in Patients with Chronic Heart Failure with Preserved Ejection Fraction) trial.

METHODS:

Of 5,988 study participants, 5,986 (99.9%) and 5,825 (97.3%) had available baseline NT-proBNP and hs-cTnT; postbaseline NT-proBNP was also available. Baseline characteristics were expressed by biomarker quartiles. The effect of empagliflozin on cardiovascular death/ HF hospitalization, the individual components, total HF hospitalizations, slope of decline of estimated glomerular filtration rate (eGFR), and a composite renal endpoint were examined across biomarker quartiles. Change in NT-proBNP across study visits as a function of treatment assignment was also assessed.

RESULTS:

Higher baseline NT-proBNP and hs-cTnT concentrations were associated with more comorbidities and worse HF severity. Incidence rates for cardiac and renal outcomes were 2- to 5-fold higher among those in the highest vs lowest NT-proBNP or hs-cTnT quartiles. Empagliflozin consistently reduced the risk for cardiovascular events and reduced slope of eGFR decline across NT-proBNP or hs-cTnT quartiles. Empagliflozin treatment modestly lowered NT-proBNP; by 100 weeks, the adjusted mean difference in NT-proBNP from placebo was 7%. Increase in NT-proBNP from baseline to 12 weeks was strongly associated with risk of cardiovascular death/HF hospitalization.

CONCLUSIONS:

The benefit of empagliflozin on cardiac outcomes and decline of eGFR is preserved across the wide range of baseline NT-proBNP and hs-cTnT evaluated. Empagliflozin modestly reduces NT-proBNP in HF with preserved ejection fraction. (EMPagliflozin outcomE tRial in Patients With chrOnic heaRt Failure With Preserved Ejection Fraction [EMPEROR-Preserved]; NCT03057951).

• Authors: James L Januzzi Jr, Javed Butler, Faiez Zannad, Gerasimos Filippatos, João Pedro Ferreira, Stuart J Pocock, Naveed Sattar, Subodh Verma, Ola Vedin, Tomoko Iwata, Martina Brueckmann, Milton Packer, Stefan D Anker, EMPEROR-Preserved Trial Study Group
• Journal: JACC. Heart failure (JACC Heart Fail) Vol. 10 Issue 7 Pg. 512-524 (07 2022) ISSN: 2213-1787 [Electronic] United States
• PMID: 35670067 (Publication Type: Journal Article)
• Copyright: Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.

Chemical References

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

Topics

• Biomarkers
• Chronic Disease
• Clinical Trials as Topic
• Heart Failure (drug therapy)
• Humans
• Natriuretic Peptide, Brain
• Peptide Fragments
• Prognosis
• Troponin T