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NT-proBNP and Troponin I in Cardiac Function
Quick Takes
- Elevated baseline NT-proBNP and hs-cTnI levels predict a decline in cardiac systolic and diastolic function over 7 years in older adults.
- No significant association was found between hs-cTnT and changes in cardiac structure or function.
- Additional research is needed to validate these associations and establish optimal strategies for integrating biomarker-based risk stratification into clinical practice.
Study Questions:
How do N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high-sensitivity cardiac troponin T (hs-cTnT) and I (hs-CTnI) predict long-term changes in cardiac structure and function in older adults?
Methods:
This prospective cohort study assessed the associations of NT-proBNP, hs-cTnT, and hs-cTnI with 7-year changes in left ventricular (LV) structure and function in older adults, using data from 2006 participants in the ARIC (Atherosclerosis Risk in Communities) study who underwent echocardiography at baseline (2011–2013) and follow-up (2018–2019). Echocardiographic measures included LV mass index, relative wall thickness, volumes, ejection fraction, global longitudinal strain (GLS), global circumferential strain (GCS), and diastolic indices (e', E/e', LAVI, TRV). Diastolic dysfunction was defined as abnormalities in at least two parameters.
Results:
The study population (mean age 74 years, 61% female, 23% Black) had median baseline biomarker levels of NT-proBNP (87 ng/L, 25th–75th percentile: 50–157 ng/L), hs-cTnT (9 ng/L, 25th–75th percentile: 6–12 ng/L), and hs-cTnI (2.6 ng/L, 25th–75th percentile: 1.9–3.9 ng/L). Over the 7-year follow-up, elevated NT-proBNP and hs-cTnI levels were significantly associated with declines in LV systolic function, including reductions in ejection fraction (mean decline 2.1% per NT-proBNP doubling; 95% confidence interval [CI], 1.5%–2.7%) and GLS (0.9% per NT-proBNP doubling; 95% CI, 0.5%–1.3%).
Higher NT-proBNP levels also predicted diastolic dysfunction, with 12% greater odds (adjusted odds ratio, 1.12; 95% CI, 1.02–1.23) for progressing from normal to abnormal diastolic function for each doubling of NT-proBNP. In contrast, hs-cTnT was not significantly associated with changes in LV structure or function (all p > 0.05). The findings were robust across sensitivity analyses, including those accounting for potential attrition bias.
Conclusions:
Baseline NT-proBNP and hs-cTnI levels, but not hs-cTnT levels, independently predict progressive declines in LV systolic and diastolic function over a 7-year period in older adults without overt cardiovascular disease.
Perspective:
This study advances our understanding of cardiac biomarkers in several ways. First, while NT-proBNP and both troponin isoforms are strong predictors of incident heart failure (HF), their associations with progressive cardiac dysfunction differ substantially. NT-proBNP and hs-cTnI appear to identify early cardiac dysfunction, while hs-cTnT's association with HF risk likely involves other pathways. Second, the findings demonstrate hs-cTnI's greater cardiac specificity compared to hs-cTnT in older adults, aligning with evidence that hs-cTnT may reflect noncardiac pathology including skeletal muscle disorders. Third, these results have direct clinical implications for biomarker selection in risk stratification. Elevated NT-proBNP and hs-cTnI may better identify individuals who would benefit from cardiac imaging surveillance and preventive interventions targeting progressive LV dysfunction.
Additional research is needed to validate these associations and establish optimal strategies for integrating biomarker-based risk stratification into clinical practice. Future studies should also investigate the mechanisms underlying hs-cTnT's association with HF given its apparent lack of correlation with progressive cardiac dysfunction.
Clinical Topics: Geriatric Cardiology, Noninvasive Imaging, Echocardiography/Ultrasound, Heart Failure and Cardiac Biomarkers
Keywords: Echocardiography, Geriatrics, Natriuretic Peptides, Troponin I
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