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Published on: October 21, 2018
High-sensitivity troponin T, NT-proBNP and glomerular filtration rate: A multimarker strategy for risk stratification
Alberto Aimo1, James L Januzzi2, Giuseppe Vergaro3
1Scuola Superiore Sant'Anna, Pisa, Italy.
Insights
High-sensitivity troponin T (hs-TnT) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) predict heart failure prognosis. hs-TnT is a stronger predictor, and both improve with estimated glomerular filtration rate (eGFR) assessment.
Area of Science:
- Cardiology
- Biomarker Research
- Prognostic Modeling
Background:
- High-sensitivity troponin T (hs-TnT) is a known prognostic predictor in chronic heart failure (HF).
- Previous studies highlighted hs-TnT's predictive power in stable HF populations.
Purpose of the Study:
- To compare the prognostic performance of hs-TnT, NT-proBNP, hs-CRP, and eGFR in a large cohort of stable chronic HF patients.
- To determine the independent predictive value of these biomarkers and their interaction with renal function.
Main Methods:
- Analysis of individual patient data from 9289 stable chronic HF patients with a median follow-up of 2.4 years.
- Multivariable modeling to assess the independent predictive performance of hs-TnT, NT-proBNP, hs-CRP, and eGFR for mortality and hospitalization.
- Evaluation of biomarker cut-offs stratified by estimated glomerular filtration rate (eGFR) classes.
Main Results:
- Both hs-TnT and NT-proBNP independently predicted all-cause mortality, cardiovascular mortality, and cardiovascular hospitalization.
- hs-TnT demonstrated stronger predictive performance than NT-proBNP.
- Estimated glomerular filtration rate (eGFR) provided independent prognostic value and influenced optimal biomarker cut-offs.
- hs-C-reactive protein (hs-CRP) did not show independent prognostic value in the presence of hs-TnT and NT-proBNP.
Conclusions:
- hs-TnT offers independent prognostic information beyond NT-proBNP in stable chronic HF.
- Concomitant assessment of eGFR refines risk stratification, with specific biomarker cut-offs for different renal function levels.
- hs-CRP is not an independent predictor in this context.
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.
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