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.
Additional risk stratification may provide more aggressive and focalized preventive treatment to high-risk hypertensive patients according to the Japanese 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 heart failure (HF) in high-risk hypertensive patients with preserved left ventricular ejection fraction (LVEF). Baseline hsTnI and NT-proBNP levels and echocardiography data were obtained for 493 Japanese hypertensive outpatients (mean age, 68.5 years) with LVEF ≥ 50%, no symptomatic HF, and at least one of the following comorbidities: stage 3-4 chronic kidney disease, diabetes mellitus, and stable coronary artery disease. During a mean follow-up period of 86.1 months, 44 HF admissions occurred, including 31 for HF with preserved ejection fraction (HFpEF) and 13 for HF with reduced ejection fraction (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 hsTnI (≥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 (p < 0.05), net reclassification improvement (p = 0.0001), and integrated discrimination improvement (p < 0.05) to a greater extent than that of any single biomarker. 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.
Department of Cardiology, Fujita Health University School of Medicine, Toyoake, Japan.
Ryunosuke
R
Okuyama
Department of Joint Research Laboratory of Clinical Medicine, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, 470-1192, Japan. jishii@fujita-hu.ac.jp.
Junnichi
J
Ishii
Division of Statistics, Fujita Health University School of Medicine, Toyoake, Japan.
Hiroshi
H
Takahashi
Department of Cardiology, Fujita Health University School of Medicine, Toyoake, Japan.
Hideki
H
Kawai
Department of Cardiology, Fujita Health University School of Medicine, Toyoake, Japan.
Takashi
T
Muramatsu
Department of Cardiology, Fujita Health University School of Medicine, Toyoake, Japan.
Masahide
M
Harada
Department of Cardiology, Fujita Health University School of Medicine, Toyoake, Japan.
Akira
A
Yamada
Department of Cardiology, Fujita Health University School of Medicine, Toyoake, Japan.
Sadako
S
Motoyama
Department of Cardiology, Fujita Health University School of Medicine, Toyoake, Japan.
Shigeru
S
Matsui
Department of Joint Research Laboratory of Clinical Medicine, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, 470-1192, Japan.
Hiroyuki
H
Naruse
Department of Cardiology, Fujita Health University School of Medicine, Toyoake, Japan.
Masayoshi
M
Sarai
Department of Nephrology, Fujita Health University School of Medicine, Toyoake, Japan.
Midori
M
Hasegawa
Department of Cardiology, Fujita Health University School of Medicine, Toyoake, Japan.
Eiichi
E
Watanabe
Department of Endocrinology and Metabolism, Fujita Health University School of Medicine, Toyoake, Japan.
Atsushi
A
Suzuki
Department of Cardiology, Banbuntane Houtokukai Hospital, Nagoya, Japan.
Mutsuharu
M
Hayashi
Department of Cardiology, Banbuntane Houtokukai Hospital, Nagoya, Japan.
Hideo
H
Izawa
Department of Nephrology, Fujita Health University School of Medicine, Toyoake, Japan.
Yukio
Y
Yuzawa
Department of Cardiology, Fujita Health University School of Medicine, Toyoake, Japan.
Yukio
Y
Ozaki
D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D015150:Echocardiography, Doppler; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000503:physiopathology*; D006760:Hospitalization; D006801:Humans; D006973:Hypertension / Q000150:complications; D007564:Japan; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000150:complications; D013318:Stroke Volume; D019210:Troponin I / Q000097:blood*; D016277:Ventricular Function, Left
D015415:Biomarkers; D019210:Troponin I; D020097:Natriuretic Peptide, Brain
Heart failure admission; High-sensitivity troponin I; Hypertension; N-terminal pro-B-type natriuretic peptide