Prognostic Assessment of Elderly Patients with Symptoms of Heart Failure by Combining High-Sensitivity Troponin T and N-Terminal Pro–B-Type Natriuretic Peptide Measurements

Abstract

BACKGROUND N-terminal pro–B-type natriuretic peptide (NT-proBNP) is a useful biomarker in heart failure assessment, whereas measurement of cardiac troponin is central in the diagnosis of patients with acute coronary syndromes. This report examined the prognostic use of combining high-sensitivity cardiac troponin T (hs-cTnT) and NT-proBNP measurements in elderly patients presenting to a primary care center with symptoms associated with heart failure. METHODS A total of 470 elderly patients (age range 65–86 years) presenting with symptoms of heart failure were recruited from primary healthcare. In addition to clinical examination and echocardiography, hs-cTnT and NT-proBNP plasma concentrations were measured. All patients were followed for 10 years, and cardiovascular mortality was registered. RESULTS By use of the hs-cTnT assay, 80.4% of the population had plasma concentrations above the lower detection limit of the assay. Of those displaying a plasma concentration of hs-cTnT >99th percentile of a healthy population, 43% also had an NT-proBNP concentration in the fourth quartile (>507 ng/L). In the multivariate analysis, we observed a 2.5-fold increased risk for cardiovascular mortality in individuals with a plasma NT-proBNP concentration >507 ng/L (P < 0.0001). Conversely, patients with hs-cTnT >99th percentile displayed an approximately 2-fold increased risk for cardiovascular mortality (P = 0.0002). Combining the 2 biomarkers, NT-proBNP concentrations >507 ng/L with hs-cTnT >99th percentile increased the risk 3-fold, even after adjustment for clinical variables such as age, sex, impaired estimated glomerular filtration rate, and anemia (P < 0.0001). CONCLUSIONS hs-cTnT and NT-proBNP measurements combined provide better prognostic information than using either biomarker separately in elderly patients with symptoms associated with heart failure.

Troponin T levels in patients with acute heart failure: clinical and prognostic significance of their detection and release during hospitalisation

“…Earlier studies with second and third generation assays for cTn showed that both biomarkers are independently related with future cardiac events [47], with an additive prognostic value [12,48,49]. Similar conclusions were reached also in studies evaluating NP and hsTn [16,50,51]. This is consistent with the fact that Tn and NPs are related to different pathophysiological mechanisms: myocardial stretch and myocardial damage, respectively.…”

Effect of a 180 mg ticagrelor loading dose on myocardial necrosis in patients undergoing elective percutaneous coronary intervention: A preliminary study

“…The reduction of platelet aggregation at 0 h and 2 h after PCI relative to pre PCI value in both DM and non-DM groups. Data are shown as mean ± SEM; DM -diabetes mellitus; *p < 0.05. other non-ischemic factors such as heart failure, diabetes mellitus and ventricular hypertrophy [14,24]. Correlation analysis was done between hs-cTnT 2h after PCI and baseline characteristics of patients, and it was found that hs-cTnT 2h after PCI was strongly associated only with baseline hs-cTnT level, but not with other factors, suggesting that hs-cTnT levels at 2 h after PCI in our patients is not significantly affected by other factors.…”

Serial Measurement of Cardiac Troponin T Using a Highly Sensitive Assay in Patients With Chronic Heart Failure

“…8,9,21,22 In the 2 largest samples studied to date, hs-cTnT was indeed detectable (Ն3 ng/L) in 86% of the patients in Val-HeFT and 98% of those from GISSI-HF. However, the exact mechanisms for troponin release from cardiac myocytes and its clearance from the circulation remain speculative, especially in chronic HF.…”