Combined measurements of cardiac troponin T and N-terminal pro-brain natriuretic peptide in patients with chronic heart failure

Abstract

Objective: To examine the prognostic contribution of combined cardiac troponin T(cTnT) and N-terminal pro-brain natriuretic peptide(NT-proBNP) in patients with compensated and decompensated chronic heart failure(CHF) in absence of acute coronary syndrome. Design and patient population: Between July 2001 and March 2002, 73 consecutive patients (mean age = 68.2 ± 1.4years,39men) hospitalised for decompensated or stable CHF were studied and followed until December 2002. Main outcome measures: Serum cTnT and NT-proBNP were measured on admission. Actuarial rates of adverse cardiac events, including sudden or CHF death, or rehospitalisation for CHF during follow-up were compared among patients grouped according to initial serum cTnT and NT-proBNP concentrations, singly or in combination. Results: The cut-off value for NT-proBNP predictive of cardiac decompensation was 1050pg/ml. NT-proBNP was significantly higher among 46 patients with, than among 27 patients without, decompensated CHF(7167 ± 2318 vs.1360 ± 286pg/ml, P < 0.01). The serum concentration of cTnT upon admission was > 0.02ng/ml in 22 of the 73 patients. High cTnT values were measured in 17 of 46 patients(37%)(0.037 ± 0.004ng/ml) with, and in 5 of 27 patients(18.5%)(0.038 ± 0.002ng/ml) without, cardiac decompensation. The 18 patients with high concentrations of both cTnT and NT-proBNP had a lower adverse cardiac event-free rate than the 31 patients with low cTnT and low NT-proBNP on study entry(P < 0.005). Conclusions: Combined measurements of serum cTnT and NT-proBNP were reliable prognostic markers of adverse cardiac event in patients with CHF.