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The prognostic value of troponin T and N-terminal pro B-type natriuretic peptide, alone and in combination, in heart failure patients with and without diabetes

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

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  • Rasmus Rørth
  • Pardeep S Jhund
  • Søren L Kristensen
  • Akshay S Desai
  • Lars Køber
  • Jean L Rouleau
  • Scott D Solomon
  • Karl Swedberg
  • Michael R Zile
  • Milton Packer
  • John J V McMurray
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AIMS: We examined the prognostic importance of N-terminal pro B-type natriuretic peptide (NT-proBNP) and troponin T (TnT) in heart failure patients with and without diabetes.

METHODS AND RESULTS: We measured NT-proBNP and TnT in the biomarker substudy of the Prospective Comparison of ARNI With ACEI to Determine Impact on Global Mortality and Morbidity in Heart Failure trial (PARADIGM-HF). Of 1907 patients, 759 (40%) had diabetes. Median TnT in patients with diabetes was 18 (interquartile range 11-27) ng/L and 13 (9-21) ng/L in those without (P < 0.001). The TnT frequency-distribution curve was shifted to the right in patients with diabetes, compared to those without diabetes. By contrast, NT-proBNP did not differ between patients with and without diabetes. Diabetes and each biomarker were predictive of worse outcomes. Thus, patients with diabetes, an elevated TnT and a NT-proBNP level in the highest tertile (9% of all patients) had an absolute risk of cardiovascular death or heart failure hospitalization of 265 per 1000 person-years, compared to a rate of 42 per 1000 person-years in those without diabetes, a TnT < 18 ng/L and a NT-proBNP in the lowest tertile (16% of all patients). TnT remained an independent predictor of adverse outcomes in multivariable analyses including NT-proBNP.

CONCLUSION: TnT is elevated to a greater extent in heart failure patients with diabetes compared to those without (whereas NT-proBNP is not). TnT and NT-proBNP are additive in predicting risk and when combined help identify diabetes patients at extremely high absolute risk.

OriginalsprogEngelsk
TidsskriftEuropean Journal of Heart Failure
Vol/bind21
Udgave nummer1
Sider (fra-til)40-49
Antal sider10
ISSN1388-9842
DOI
StatusUdgivet - 1 jan. 2019

ID: 56241895