High-sensitivity troponin T, NT-proBNP and glomerular filtration rate: A multimarker strategy for risk stratification in chronic heart failure

Alberto Aimo*, James L. Januzzi, Giuseppe Vergaro, Andrea Ripoli, Roberto Latini, Serge Masson, Michela Magnoli, Inder S. Anand, Jay N. Cohn, Luigi Tavazzi, Gianni Tognoni, Jørgen Gravning, Thor Ueland, Ståle H. Nymo, Hans Peter Brunner La Rocca, Antoni Bayes-Genis, Josep Lupón, Rudolf A. de Boer, Akiomi Yoshihisa, Yasuchika TakeishiMichael Egstrup, Ida Gustafsson, Hanna K. Gaggin, Kai M. Eggers, Kurt Huber, Ioannis Tentzeris, W. H. Wilson Tang, Justin L. Grodin, Claudio Passino, Michele Emdin

*Corresponding author for this work

Research output: Contribution to journalArticleResearchpeer-review

29 Citations (Scopus)


Background: In a recent individual patient data meta-analysis, high-sensitivity troponin T (hs-TnT) emerged as robust predictor of prognosis in stable chronic heart failure (HF). In the same population, we compared the relative predictive performances of hs-TnT, N-terminal fraction of pro-B-type natriuretic peptide (NT-proBNP), hs-C-reactive protein (hs-CRP), and estimated glomerular filtration rate (eGFR) for prognosis. Methods and results: 9289 patients (66 ± 12 years, 77% men, 85% LVEF <40%, 60% ischemic HF) were evaluated over a 2.4-year median follow-up. Median eGFR was 58 mL/min/1.73 m2 (interquartile interval 46–70; n = 9220), hs-TnT 16 ng/L (8–20; n = 9289), NT-proBNP 1067 ng/L (433–2470; n = 8845), and hs-CRP 3.3 mg/L (1.4–7.8; n = 7083). In a model including all 3 biomarkers, only hs-TnT and NT-proBNP were independent predictors of all-cause and cardiovascular mortality and cardiovascular hospitalization. hs-TnT was a stronger predictor than NT-proBNP: for example, the risk for all-cause death increased by 54% per doubling of hs-TnT vs. 24% per doubling of NT-proBNP. eGFR showed independent prognostic value from both hs-TnT and NT-proBNP. The best hs-TnT and NT-proBNP cut-offs for the prediction of all-cause death increased progressively with declining renal function (eGFR ≥ 90: hs-TnT 13 ng/L and NT-proBNP 825 ng/L; eGFR < 30: hs-TnT 40 ng/L and NT-proBNP 4608 ng/L). Patient categorization according to these cut-offs effectively stratified patient prognosis across all eGFR classes. Conclusions: hs-TnT conveys independent prognostic information from NT-proBNP, while hs-CRP does not. Concomitant assessment of eGFR may further refine risk stratification. Patient classification according to hs-TnT and NT-proBNP cut-offs specific for the eGFR classes holds prognostic significance.

Original languageAmerican English
Pages (from-to)166-172
Number of pages7
JournalInternational Journal of Cardiology
Publication statusPublished - 15 Feb 2019


  • Heart failure
  • Prognosis
  • Renal function
  • Troponin


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