Relationships of N-terminal pro-B-natriuretic peptide and cardiac troponin T to left ventricular mass and function and mortality in asymptomatic hemodialysis patients.
BACKGROUND
Although the cardiac biomarker troponin T (cTnT) is related strongly to mortality in patients with end-stage renal disease, the independent association of N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) and cTnT levels in predicting outcomes is unknown. The objective of this study is to determine factors associated with NT-pro-BNP and cTnT and determine whether these levels are associated with mortality.


METHODS
Cohort study.


METHODS
Asymptomatic hemodialysis patients (n = 150) in 4 university-affiliated hemodialysis units. EXPOSURE & OUTCOMES: For cross-sectional analysis, echocardiographic variables as exposures and NT-pro-BNP and cTnT levels as outcomes; for longitudinal analysis, association of NT-pro-BNP and cTnT levels as exposures to all-cause and cardiovascular disease mortality as outcomes.


RESULTS
In a multivariate regression analysis, low midwall fractional shortening, a measure of poor systolic function, was an independent correlate of log NT-pro-BNP level (P < 0.01), whereas left ventricular mass index was an independent correlate of cTnT level (P < 0.01). During a median follow-up of 24 months, 46 patients died, 26 of cardiovascular causes. NT-pro-BNP levels had a strong graded relationship with all-cause (hazard ratios [HRs], 1.54, 4.78, and 4.03 for increasing quartiles; P < 0.001) and cardiovascular mortality (HRs, 2.99, 10.95, and 8.54; P < 0.01), whereas cTnT level had a weaker relationship with all-cause (HRs, 1.57, 2.32, and 3.39; P < 0.01) and cardiovascular mortality (HRs, 0.81, 2.12, and 2.14; P = 0.1). The combination of the 2 biomarker levels did not improve the association with all-cause or cardiovascular mortality compared with NT-pro-BNP level alone. NT-pro-BNP level was a marker of mortality even after adjusting for left ventricular mass index and midwall fractional shortening.


CONCLUSIONS
Our cohort was predominantly black and of limited sample size.


CONCLUSIONS
NT-pro-BNP level strongly correlates with left ventricular systolic dysfunction and is associated more strongly with mortality than cTnT level in asymptomatic hemodialysis patients.
Indiana University School of Medicine and Richard L. Roudebush Veterans Administration Medical Center, Indianapolis, IN 46202, USA.
Sangeetha
S
Satyan
Robert P
RP
Light
Rajiv
R
Agarwal
D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000378:metabolism; D015331:Cohort Studies; D018450:Disease Progression; D004452:Echocardiography; D005260:Female; D006352:Heart Ventricles / Q000473:pathology* / Q000503:physiopathology; D006801:Humans; D007676:Kidney Failure, Chronic / Q000378:metabolism* / Q000503:physiopathology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000378:metabolism; D020097:Natriuretic Peptide, Brain / Q000378:metabolism*; D010446:Peptide Fragments / Q000378:metabolism*; D011237:Predictive Value of Tests; D011379:Prognosis; D012044:Regression Analysis; D006435:Renal Dialysis; D016019:Survival Analysis; D020107:Troponin T / Q000378:metabolism*; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology*
D015415:Biomarkers; D010446:Peptide Fragments; D020107:Troponin T; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain