Admission high-sensitivity troponin T and NT-proBNP for outcome prediction in acute heart failure.
Acute Disease
Aged
Aged, 80 and over
Biomarkers
/ blood
Cohort Studies
Female
Heart Failure
/ blood
Hospital Mortality
/ trends
Humans
Male
Natriuretic Peptide, Brain
/ blood
Patient Admission
/ trends
Peptide Fragments
/ blood
Prognosis
Retrospective Studies
Risk Factors
Treatment Outcome
Troponin T
/ blood
Acute heart failure
NT-proBNP
Prognosis
Troponin T
Journal
International journal of cardiology
ISSN: 1874-1754
Titre abrégé: Int J Cardiol
Pays: Netherlands
ID NLM: 8200291
Informations de publication
Date de publication:
15 10 2019
15 10 2019
Historique:
received:
28
02
2019
revised:
30
05
2019
accepted:
03
06
2019
pubmed:
16
6
2019
medline:
14
7
2020
entrez:
16
6
2019
Statut:
ppublish
Résumé
High-sensitivity troponin T (hs-TnT) reflects the severity of ongoing myocardial damage. In acute heart failure (AHF), its additive prognostic value over B-type natriuretic peptides is unclear. Individual data of 1499 AHF patients with admission hs-TnT were collected from 3 cohorts. Patients (78 ± 10 years, 51% men, N-terminal fragment of pro-B-type natriuretic peptide - NT-proBNP - 5660 [2693-12,466], hs-TnT 43 ng/L [26-69]) experiencing in-hospital death (n = 187, 13%) had significantly higher hs-TnT and NT-proBNP on admission (both p < 0.001). Patients with hs-TnT ≥43 ng/L and NT-proBNP ≥5660 ng/L had a 2.7-fold higher risk of in-hospital death (relative risk - RR 2.7, 95% confidence interval - CI 1.7-4.5). Among discharged patients, 1024 deaths (81%) occurred over 11 months (4-22). In the whole population, hs-TnT ≥43 ng/L predicted all-cause death at 6, 12 and 24 months independently from NT-proBNP ≥5660 ng/L. The best NT-proBNP cut-off for in-hospital mortality (4382 ng/L) independently predicted this endpoint, while the best hs-TnT cut-off (55 ng/L) did not. Patients with NT-proBNP ≥4382 ng/L and hs-TnT ≥55 ng/L had a 12-fold higher risk of in-hospital death (RR 11.7, 95% CI 6.9-19.7). The best hs-TnT cut-offs independently predicted all post-discharge outcomes. The best NT-proBNP cut-off (4382 ng/L) independently predicts outcome, while the best hs-TnT (55 ng/L) does not; patients with both biomarkers ≥best cut-offs have a 12-fold higher risk of in-hospital mortality. Admission hs-TnT ≥43 ng/L and the best hs-TnT cut-offs hold independent prognostic significance for post-discharge outcome, while hs-TnT seems less predictive than NT-proBNP when considering absolute values.
Sections du résumé
BACKGROUND
High-sensitivity troponin T (hs-TnT) reflects the severity of ongoing myocardial damage. In acute heart failure (AHF), its additive prognostic value over B-type natriuretic peptides is unclear.
METHODS
Individual data of 1499 AHF patients with admission hs-TnT were collected from 3 cohorts.
RESULTS
Patients (78 ± 10 years, 51% men, N-terminal fragment of pro-B-type natriuretic peptide - NT-proBNP - 5660 [2693-12,466], hs-TnT 43 ng/L [26-69]) experiencing in-hospital death (n = 187, 13%) had significantly higher hs-TnT and NT-proBNP on admission (both p < 0.001). Patients with hs-TnT ≥43 ng/L and NT-proBNP ≥5660 ng/L had a 2.7-fold higher risk of in-hospital death (relative risk - RR 2.7, 95% confidence interval - CI 1.7-4.5). Among discharged patients, 1024 deaths (81%) occurred over 11 months (4-22). In the whole population, hs-TnT ≥43 ng/L predicted all-cause death at 6, 12 and 24 months independently from NT-proBNP ≥5660 ng/L. The best NT-proBNP cut-off for in-hospital mortality (4382 ng/L) independently predicted this endpoint, while the best hs-TnT cut-off (55 ng/L) did not. Patients with NT-proBNP ≥4382 ng/L and hs-TnT ≥55 ng/L had a 12-fold higher risk of in-hospital death (RR 11.7, 95% CI 6.9-19.7). The best hs-TnT cut-offs independently predicted all post-discharge outcomes.
CONCLUSIONS
The best NT-proBNP cut-off (4382 ng/L) independently predicts outcome, while the best hs-TnT (55 ng/L) does not; patients with both biomarkers ≥best cut-offs have a 12-fold higher risk of in-hospital mortality. Admission hs-TnT ≥43 ng/L and the best hs-TnT cut-offs hold independent prognostic significance for post-discharge outcome, while hs-TnT seems less predictive than NT-proBNP when considering absolute values.
Identifiants
pubmed: 31200964
pii: S0167-5273(19)31104-0
doi: 10.1016/j.ijcard.2019.06.005
pii:
doi:
Substances chimiques
Biomarkers
0
Peptide Fragments
0
Troponin T
0
pro-brain natriuretic peptide (1-76)
0
Natriuretic Peptide, Brain
114471-18-0
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
137-142Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2019 Elsevier B.V. All rights reserved.