High-Sensitivity Troponin T and N-Terminal Pro-B-Type Natriuretic Peptide (NT-proBNP) and Risk of Incident Heart Failure in Patients with CKD

Abstract

High-sensitivity troponin T (hsTnT) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) strongly predict heart failure (HF) in the general population. However, the interpretation of levels of these biomarkers as predictors of HF is uncertain among patients with CKD. Here, we investigated whether hsTnT and NTproBNP are associated with incident HF among patients with CKD. In a prospective cohort analysis, we studied 3483 people with CKD in the Chronic Renal Insufficiency Cohort (CRIC) Study recruited from June of 2003 to August of 2008 who were free of HF at baseline. We used Cox regression to examine the association of baseline levels of hsTnT and NT-proBNP with incident HF after adjustment for demographic factors, traditional cardiovascular risk factors, markers of kidney disease, pertinent medication use, and mineral metabolism markers. At baseline, hsTnT levels ranged from #5.0 to 378.7 pg/ml, and NT-proBNP levels ranged from #5 to 35,000 pg/ml. Compared with those who had undetectable hsTnT, participants in the highest quartile (.26.5 ng/ml) had a significantly higher rate of HF (hazard ratio, 4.77; 95% confidence interval, 2.49 to 9.14). Similarly, compared with those in the lowest NT-proBNP quintile (,47.6 ng/ml), participants in the highest quintile (.433.0 ng/ml) experienced a substantially higher rate of HF (hazard ratio, 9.57; 95% confidence interval, 4.40 to 20.83). In conclusion, hsTnT and NT-proBNP were strongly associated with incident HF among a diverse cohort of individuals with mild to severe CKD. Elevations in these biomarkers may indicate subclinical changes in volume and myocardial stress that subsequently contribute to clinical HF.

Associations of Conventional Echocardiographic Measures with Incident Heart Failure and Mortality: The Chronic Renal Insufficiency Cohort

“…LVH is likely a multifactorial process including known or unknown inflammatory and fibrotic mediators that were not measured in this investigation. We also adjusted for two markers of end organ damage, BNP and troponin T, and found that LVMI predicted HF independently of these powerfully prognostic biomarkers in CKD (24).…”

Prognostic Value of Coronary Flow Reserve in Patients with Dialysis-Dependent ESRD

“…6 Myocardial ischemia resulting from supply-demand mismatch may lead to low-level myocardial injury and regional wall motion abnormalities and may explain the association between elevated high-sensitivity cardiac troponin T and incident heart failure in patients with dd-ESRD without coronary artery disease. 13,14 Second, impaired global CFR may also reflect microvascular dysfunction resulting from arteriolar remodeling, 15 endothelial dysfunction, and/or increased extravascular resistance (i.e., left ventricular hypertrophy or interstitial fibrosis), all of which have been documented in patients with uremia 16 and may be contributors to subclinical myocardial ischemia and injury.…”

Heart failure in patients with kidney disease

“…In the European Prevention of Renal and Vascular Endstage Disease (PREVEND) study of over 1000 patients with CKD, elevations in NT pro-BNP and hs-TnT were significantly associated with cardiovascular events (defined as MI, ischaemic heart disease and coronary artery bypass grafting or percutaneous coronary angioplasty) 14. The 2015 CRIC study specifically evaluated for incident HF and found that patients with CKD in the highest quartiles of NT pro-BNP and hs-TnT had a nearly 10-fold and fivefold higher risk of incident HF, respectively 15. However, the use of these biomarkers in the clinical setting still remains controversial since there are no accepted cut-offsin the CKD population.…”