Key result
Increased cTnT (>0.01 micro g/L) and BNP (>160 ng/L) 2 months after treatment initiation were independent predictors of cardiac events in patients with chronic heart failure (P<0.001).
Why the study?
Does the combination of cTnT and BNP measured 2 months after treatment initiation predict cardiac events in patients with chronic heart failure?
Cohort (n=100)
Does the combination of cTnT and BNP measured 2 months after treatment initiation predict cardiac events in patients with chronic heart failure?
The combination of cTnT and BNP measured 2 months after treatment initiation effectively stratifies risk for subsequent cardiac mortality and morbidity in patients with chronic heart failure.
Supports combined cTnT/BNP measurement for risk stratification in chronic HF; leaves open prospective validation before guiding therapy.
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) micro g/L] and BNP [249 (276) vs 753 (598) ng/L], percentage increased cTnT (>0.01 micro g/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 micro g/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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Ishii et al. (2003) conducted a cohort in Chronic Heart Failure (n=100). cTnT and BNP measurement was evaluated on Cardiac events (cardiac deaths and readmissions for worsening CHF) (p=<0.001). Increased cTnT (>0.01 micro g/L) and BNP (>160 ng/L) 2 months after treatment initiation were independent predictors of cardiac events in patients with chronic heart failure (P<0.001).
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