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Prognostic Value of Combination of Cardiac Troponin T and B-Type Natriuretic Peptide after Initiation of Treatment in Patients with Chronic Heart Failure

¹ Division of Critical Care, Fujita Health University Graduate School of Health Sciences, ² Department of Internal Medicine, Fujita Health University School of Medicine, ³ Department of Joint Research Laboratory of Clinical Medicine, Fujita Health University Hospital, and ⁴ Department of Clinical Chemistry, Fujita Health University School of Health Sciences, Toyoake 470-1192, Japan.

^aAddress correspondence to this author at: Division of Critical Care, Fujita Health University Graduate School of Health Sciences, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake 470-1192, Japan. Fax 81-562-93-2315; e-mail jishii{at}fujita-hu.ac.jp.

Background: Recent studies have suggested that cardiac troponin T (cTnT) and troponin I may detect ongoing myocardial damage involved in the progression of chronic heart failure (CHF). This study was prospectively designed to examine whether the combination of cTnT, a marker for ongoing myocardial damage, and B-type natriuretic peptide (BNP), a marker for left ventricular overload, would effectively stratify patients with CHF after initiation of treatment.

Methods: We measured serum cTnT, plasma BNP, and left ventricular ejection fraction (LVEF) on admission for worsening CHF [New York Heart Association (NYHA) functional class III to IV] and 2 months after initiation of treatment to stabilize CHF (n = 100; mean age, 68 years).

Results: Mean (SD) concentrations of cTnT [0.023 (0.066) vs 0.063 (0.20) µg/L] and BNP [249 (276) vs 753 (598) ng/L], percentage increased cTnT (>0.01 µg/L; 35% vs 60%), NYHA functional class [2.5 (0.6) vs 3.5 (5)], and LVEF [43 (13)% vs 36 (12)%] were significantly (P <0.01) improved 2 months after treatment compared with admission. During a mean follow-up of 391 days, there were 44 cardiac events, including 12 cardiac deaths and 32 readmissions for worsening CHF. On a stepwise Cox regression analysis, increased cTnT and BNP were independent predictors of cardiac events (P <0.001). cTnT >0.01 µg/L and/or BNP >160 ng/L 2 months after initiation of treatment were associated with increased cardiac mortality and morbidity rates.

Conclusion: The combination of cTnT and BNP measurements after initiation of treatment may be highly effective for risk stratification in patients with CHF.

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