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This Article Full Text Full Text (PDF) 074047.Supplemental Data All Versions of this Article: clinchem.2006.074047v1 53/3/412    most recent Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (4) Citing Articles via Google Scholar Google Scholar Articles by Sakhuja, R. Articles by Januzzi, J. L. Search for Related Content PubMed PubMed Citation Articles by Sakhuja, R. Articles by Januzzi, J. L., Jr. Related Collections Proteomics and Protein Markers

Amino-Terminal Pro–Brain Natriuretic Peptide, Brain Natriuretic Peptide, and Troponin T for Prediction of Mortality in Acute Heart Failure

Department of¹ Medicine, ² Cardiology Division, and ³ Clinical Laboratories, Massachusetts General Hospital, Boston, MA.

^aAddress correspondence to this author at: Clinical Laboratories, Massachusetts General Hospital, Yawkey 5984, 32 Fruit Street, Boston, MA 02114. Fax 617-643-1620; e-mail JJanuzzi{at}Partners.org.

Background: Combining testing for natriuretic peptides [amino-terminal pro–brain natriuretic peptide (NT-proBNP) and brain natriuretic peptide (BNP)] and cardiac troponin T (cTnT) may help predict mortality in patients with acute heart failure (HF).

Methods: We studied 209 patients with acute HF at an urban academic center and used ROC curves and multivariate analyses to examine the relationship of outcome to natriuretic peptide and cTnT concentrations at presentation.

Results: Higher concentrations of natriuretic peptides and cTnT at presentation were predictors of death at 60 days and 1 year (P <0.001 and P <0.01, respectively, at both time points). Optimal cutoff points for NT-proBNP, BNP, and cTnT for predicting death by 60 days or 1 year were 5562 and 3174 ng/L, 428 and 352 ng/L, and 0.01 and 0.01 µg/L, respectively. Most decedents demonstrated increased concentrations of both natriuretic peptides and cTnT and had a 25% mortality rate at the 60-day time point (P <0.001). Mortality rates were low (<4%) among patients with either no increase or an increase in only 1 marker. Decedents with increases in both a natriuretic peptide and cTnT at presentation had the highest death rate at 1 year (45%, P <0.001). This combination was strongly predictive of death [NT-proBNP plus cTnT: hazard ratio (HR), 7.66; 95% confidence interval (CI), 3.06–17.8; BNP plus cTnT: HR, 6.82; 95% CI, 2.99–16.5].

Conclusions: A dual-marker strategy incorporating a natriuretic peptide and cTnT is superior to either marker alone for estimating short- and longer-term risk in patients with acute HF.

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