Abstract 17193: Combination of High-sensitivity Troponin I and N-terminal Pro-B-type Natriuretic Peptide Predicts Future Hospital Admission for Heart Failure in High-risk Hypertensive Patients With Preserved Left Ventricular Ejection Fraction
Background: Additional risk stratification may provide more aggressive and focalized preventive treatment to high-risk hypertensive patients according to current hypertension guidelines. We prospectively investigated the predictive value of high-sensitivity troponin I (hsTnI), both independently and in combination with N-terminal pro-B-type natriuretic peptide (NT-proBNP), for incident HF in high-risk hypertensive patients with preserved left ventricular ejection fraction (LVEF).
Methods: Baseline hsTnI and NT-proBNP levels and echocardiography data were obtained for 493 hypertensive outpatients (mean age of 68.5 yrs) with LVEF ≥ 50%, no symptomatic HF, and at least one of the following comorbidities: stage 3 or 4 chronic kidney disease, diabetes, and stable coronary artery disease.
Results: During a mean follow-up period of 86.1 months, 44 HF admissions occurred, including 31 for HF with preserved LVEF (HFpEF) and 13 for HF with reduced LVEF (HFrEF; LVEF < 50%). Both hsTnI (P < 0.01) and NT-proBNP (P < 0.005) levels were significant independent predictors of HF admission. Furthermore, when the patients were stratified into 4 groups according to increased hsTnT (≥ highest tertile value of 10.6 pg/ml) and/or increased NT-proBNP (≥ highest tertile value of 239.7 pg/ml), the adjusted relative risks for patients with increased levels of both biomarkers versus neither biomarker were 13.5 for HF admission (P < 0.0001), 9.45 for HFpEF (P = 0.0009), and 23.2 for HFrEF (P = 0.003). Finally, the combined use of hsTnI and NT-proBNP enhanced the C-index, net reclassification improvement (NRI), and integrated discrimination improvement (IDI) to a greater extent than that of any single biomarker and the baseline model alone (Table).
Conclusions: The combination of hsTnI and NT-proBNP, which are individually independently predictive of HF admission, could improve predictions of incident HF in high-risk hypertensive patients but could not predict future HF phenotypes.
Author Disclosures: R. Okuyama: None. J. Ishii: None. H. Takahashi: None. H. Kawai: None. T. Takashi: None. M. Harada: None. A. Yamada: None. S. Motoyama: None. S. Matsui: None. H. Naruse: None. M. Hayashi: None. M. Sarai: None. M. Hasegawa: None. E. Watanabe: None. A. Suzuki: None. H. Hideo: None. Y. Yuzawa: None. Y. Ozaki: None.
- © 2016 by American Heart Association, Inc.