Prognostic value of combination of cardiac troponin T and B-type natriuretic peptide after initiation of treatment in patients with chronic heart failure

Background: Recent studies have suggested-that cardiac troponin. T (cTnT)and troponin I may detect ongoing myocardial damage involved in the progression of chronic heart failure (CHF). This study was,prospectively designed to examine whether the combination of, cTnT, a marker for ongoing myocardial damage, and natriuretic peptide (BNP), a marker for left ventricular overload, would effectively, stratify, patients with CHF after initiation of treatment. Methods: We measured serum cTnT; plasma BNP, and left ventricular ejection fraction (LVEF) on admission for worsening CHF [New York Heart Association (NYHA) functional class III to IV] and 2 months after initiation of treatment to stabilize CHF (n = 100; mean age, 68 years). Results: Mean (SD) concentrations of cTnT [0.023 (0.066) vs 0.063 (0.20) mug/L] and BNP [249 (276) vs 753 (598). ng/L], percentage increased cTnT. (> 0.01 mug/L; 35% vs 60%), NYHA functional class. [2.5(0:6) vs 3.5 (5)], and LVEF [43 (13)%,vs 36 (12)%]were significantly (P < 0.01) improved 2 months-after treatment compared with admission. During a. mean follow-up of 391 days, there were 44 cardiac events, including 12 cardiac deaths and 32 re admissions for worsening CHF. On a stepwise Cox regression analysis; increased cTnT and BNP were independent predictors of cardiac events (P < 0.001). cTnT > 0.01 mug/L and/or BNP > 160 ng/L 2 months after initiation of treatment were associated with increased diac mortality and morbidity rates. Conclusion: The combination of cTnT and BNP measurements after initiation of treatment may be highly effective for risk stratification in patients with CHF. (C) 2003 American Association for Clinical Chemistry.