Abstract 12683: Combined Assessment of High-Sensitive Troponin I and N-Terminal Pro-B-Type Natriuretic Peptide Levels Improves the Prediction of Future Admission for Heart Failure in Outpatients With Chronic Kidney Disease

Abstract

Background: Heart failure (HF) is a common consequence of chronic kidney disease (CKD), and it portends high risk for mortality. We prospectively investigated the predictive value of a combination of high-sensitive troponin I (hsTnI) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) for HF admission in outpatients with CKD. Methods: Baseline hsTnI and NT-proBNP levels were measured in 451 stable outpatients with CKD (estimated GFR < 60 mL/min/1.73 m 2 ) on not dialysis (mean age, 69.7 years). Using echocardiography with tissue Doppler imaging, left ventricular ejection fraction (EF) and E/e’ ratio were estimated. Among these patients, 41% had a history of cardiovascular disease, and 48% had a history of diabetes. Results: During a mean follow-up period of 924 days, there were 70 HF admissions. Patients who admitted for HF had higher hsTnI levels (22.4 vs. 10.5 pg/mL, p < 0.0001), NT-proBNP levels (1726 vs. 310 pg/mL, p < 0.0001), and E/e’ ratio (15.3 vs. 10.3, p < 0.0001), and displayed lower values of EF (55 vs. 59%, p < 0.0001) and estimated GFR (23.7 vs. 30.6 mL/min/1.73 m 2 , p = 0.009) than those who did not. Using multivariate Cox regression analysis including 11 clinical variables, increased hsTnI (relative risk, 1.98 per 10-fold increment, p = 0.02) and NT-proBNP (3.18 per 10-fold increment, p = 0.003) levels were shown to be independent predictors of HF admission. When patients were stratified into four groups according to NT-proBNP levels > a median value of 397 pg/mL and/or hsTnI levels > a median value of 11.6 pg/mL, HF admission rates were 3.1%, 7.5%, 11.8%, and 33.1%, respectively (p < 0.0001). Furthermore, when hsTnI and NT-proBNP levels were combined, the predictive values for HF admission were increased, as shown by the C-index, net reclassification improvement (NRI), and integrated discrimination improvement (IDI; Table 1). Conclusions: The combined assessment of hsTnI and NT-proBNP levels can improve the prediction of HF admission in outpatients with CKD.