title: Prognostic value of combination of cardiac troponin T and B-type natriuretic peptide after initiation of treatment in patients with chronic heart failure.
abstract: 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.
  
  
  CONCLUSIONS
  The combination of cTnT and BNP measurements after initiation of treatment may be highly effective for risk stratification in patients with CHF.
authors.affiliation: Division of Critical Care, Fujita Health University Graduate School of Health Sciences, Toyoake 470-1192, Japan. jishi@fujita-hu.ac.jp
authors.forename: Junnichi
authors.initials: J
authors.lastname: Ishii
authors.forename: Wei
authors.initials: W
authors.lastname: Cui
authors.forename: Fumihiko
authors.initials: F
authors.lastname: Kitagawa
authors.forename: Takahiro
authors.initials: T
authors.lastname: Kuno
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: Youichi
authors.initials: Y
authors.lastname: Nagamura
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kondo
authors.forename: Hisaji
authors.initials: H
authors.lastname: Oshima
authors.forename: Masanori
authors.initials: M
authors.lastname: Nomura
authors.forename: Kouji
authors.initials: K
authors.lastname: Ezaki
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Hishida
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D002908:Chronic Disease; D005260:Female; D006333:Heart Failure / Q000175:diagnosis* / Q000188:drug therapy / Q000401:mortality; D006801:Humans; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010359:Patient Readmission / Q000706:statistics & numerical data; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018570:Risk Assessment; D020107:Troponin T / Q000097:blood*; D016277:Ventricular Function, Left
chemical_list: D015415:Biomarkers; D020107:Troponin T; D020097:Natriuretic Peptide, Brain