Combined Use of High-Sensitivity Cardiac Troponin T and N-Terminal Pro-B Type Natriuretic Peptide Improves Measurements of Performance Over Established Mortality Risk Factors in Chronic Heart Failure

Study Questions:

Does the measurement of high-sensitivity cardiac troponin T (hs-cTnT) and N-terminal pro–B-type natriuretic peptide (NT-proBNP) improve risk stratification in heart failure (HF)?


This was a single-center cohort study of 876 ambulatory HF patients who were referred to a multidisciplinary HF clinic with a history of reduced ejection fraction (EF) and/or prior HF hospitalization. The additional value of hs-cTnT and NT-proBNP to that of traditional HF risk factors in predicting mortality was assessed.


Median [25th, 75th] patient age was 70 [61, 77] years, left ventricular EF was 34 [26, 43]%, and median HF duration was 27 [4.9, 74] months. One percent of patients were New York Heart Association (NYHA) class IV, 26% class III, and 66% class II. During 41 [22, 61] months of follow-up, there were 311 (36%) deaths, of which 198 were cardiac in nature. In the presence of other traditional HF risk factors, an elevated ln(hs-cTnT) and ln(NT-proBNP) was associated with 3.6 [1.5-8.2] and 1.1 [1.1-1.4] fold increases in the risk of death, respectively. While both markers led to significant integrated discrimination improvements (p < 0.05), only hs-cTnT led to an increase in net reclassification index (from 1.5-7.7%) in the presence of traditional risk factors.


The authors concluded that measurement of hs-cTnT and NT-proBNP improves risk stratification of patients with HF.


There are several biomarkers that have been studied in HF, provoking groups such as the American Heart Association to recommend a more thorough assessment of ‘information gained’ from biomarker measurement. In this analysis, hs-cTnT appears to improve risk stratification in HF. Cut-off values presented for defining hs-cTnT and NT-proBNP risk dichotomization should be interpreted with caution since levels are often prejudiced by the cohort from which they were derived. Further, the correlation of hs-cTnT and NT-proBNP with traditional HF risk factors (e.g., age, sex, NYHA classification) warrants repeat analyses of marker utility in additional cohorts.

Clinical Topics: Heart Failure and Cardiomyopathies, Acute Heart Failure, Heart Failure and Cardiac Biomarkers

Keywords: Natriuretic Peptides, Follow-Up Studies, Biological Markers, Heart Failure, Troponin T, Risk Factors, Hospitalization

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