title: Risk stratification using a combination of cardiac troponin T and brain natriuretic peptide in patients hospitalized for worsening chronic heart failure.
abstract: We prospectively evaluated whether the combination of admission measurements of a marker for myocardial cell injury and a marker for left ventricular overload would effectively risk stratify patients with acutely decompensated heart failure. We measured serum concentrations of cardiac troponin T (cTnT) using a second-generation assay, as well as serum cardiac troponin I (cTnI) and plasma atrial and brain natriuretic peptide (BNP) concentrations on admission in 98 consecutive patients hospitalized for worsening chronic heart failure (mean age 69 years; 5 patients were in New York Heart Association functional class II, 35 were in class III, and 58 patients were in class IV). During a mean follow-up period of 451 days, there were 37 cardiac events, including 21 cardiac deaths (14 in-hospital deaths) and 16 readmissions for worsening heart failure. In a stepwise Cox regression analysis, including these biochemical markers, age, sex, functional class, and left ventricular ejection fraction, cTnT, and BNP were found to be significantly independent predictors of both cardiac death (p <0.05) and cardiac events (p <0.01). A cTnT >0.033 microg/L and/or a BNP >440 pg/ml on admission was correlated with an incremental increase in in-hospital cardiac mortality, overall cardiac mortality, and cardiac event rate. Kaplan-Meier analysis revealed that this combination could reliably stratify the patients into low-, intermediate-, and high-risk groups for cardiac events. Measuring the combination of admission concentrations of cTnT and BNP may be a highly effective means of risk stratification of patients hospitalized for worsening chronic heart failure.
authors.affiliation: Division of Critical Care, Graduate School of Health Sciences, Fujita Health University, Toyoake, Japan. jishii@fujita-hu.ac.jp
authors.forename: Junnichi
authors.initials: J
authors.lastname: Ishii
authors.forename: Masanori
authors.initials: M
authors.lastname: Nomura
authors.forename: Yuu
authors.initials: Y
authors.lastname: Nakamura
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Naruse
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Mori
authors.forename: Takashi
authors.initials: T
authors.lastname: Ishikawa
authors.forename: Toshikazu
authors.initials: T
authors.lastname: Ando
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kurokawa
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kondo
authors.forename: Youichi
authors.initials: Y
authors.lastname: Nagamura
authors.forename: Kouji
authors.initials: K
authors.lastname: Ezaki
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Hishida
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000097:blood* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013318:Stroke Volume / Q000502:physiology; D013997:Time Factors; D019210:Troponin I / Q000097:blood; D020107:Troponin T / Q000097:blood*
chemical_list: D015415:Biomarkers; D019210:Troponin I; D020107:Troponin T; D020097:Natriuretic Peptide, Brain