Abstract 12112: Prognostic Value of Combination of Ultra-Sensitive Troponin I and B-Type Natriuretic Peptide in Outpatients with Chronic Kidney Disease
Background: The risk of cardiovascular events is increased in patients with chronic kidney disease (CKD). Early identification of these patients at high risk for cardiovascular events may facilitate more aggressive and focused treatment. We prospectively investigated whether the combination of ultra-sensitive troponin I (ultra-TnI), a marker for myocardial damage, and B-type natriuretic peptide (BNP), a marker for left ventricular overload, would be effective for risk stratification in outpatients with CKD.
Methods: We measured serum ultra-TnI and plasma BNP in 480 stable outpatients with CKD (estimated glomerular filtration rate [GFR] <60 ml/min/1.73m2) on not dialysis (median age, 69 yrs; 304 males). Among these patients, 33.1% had a history of cardiovascular disease, and 35.8% had diabetes.
Results: During a mean follow-up of 737 days, there were 78 (16%) cardiovascular events, including 16 cardiovascular deaths. Comparably, outpatients who had a cardiovascular event were older (median, 73 vs. 69 yrs, p = 0.001), had higher levels of ultra-TnI (23 vs. 9 pg/ml, p < 0.0001), BNP (195 vs. 38 pg/ml, p < 0.0001), high sensitive C-reactive protein (0.94 vs. 0.72 mg/l, p = 0.04) and urinary albumin excretion (997 vs. 306 mg/g creatinine, p < 0.0001), and displayed a lower level of estimated GFR (16.8 vs. 27.9 ml/min/1.73m2, p < 0.0001) than those who did not. On a multivariate Cox regression analysis including 9 clinical and biochemical variables, increased ultra-TnI (relative risk 2.72 per 10-fold increment, P = 0.001) and BNP (3.10 per 10-fold increment, P = 0.0003) were independent predictors of cardiovascular events. Ultra-TnI >median value of 10 pg/ml and/or BNP >median value of 44 pg/mL were associated with increased cardiovascular mortality and morbidity rates (Table).
Conclusion: The combination of ultra-TnI and BNP measurements may effectively stratify outpatients with CKD on not dialysis.
- © 2012 by American Heart Association, Inc.