Papers

Peer-reviewed
Jul, 2017

Combination of high-sensitivity troponin I and N-terminal pro-B-type natriuretic peptide predicts future hospital admission for heart failure in high-risk hypertensive patients with preserved left ventricular ejection fraction

HEART AND VESSELS
  • Ryunosuke Okuyama
  • Junnichi Ishii
  • Hiroshi Takahashi
  • Hideki Kawai
  • Takashi Muramatsu
  • Masahide Harada
  • Akira Yamada
  • Sadako Motoyama
  • Shigeru Matsui
  • Hiroyuki Naruse
  • Masayoshi Sarai
  • Midori Hasegawa
  • Eiichi Watanabe
  • Atsushi Suzuki
  • Mutsuharu Hayashi
  • Hideo Izawa
  • Yukio Yuzawa
  • Yukio Ozaki
  • Display all

Volume
32
Number
7
First page
880
Last page
892
Language
English
Publishing type
Research paper (scientific journal)
DOI
10.1007/s00380-017-0948-9
Publisher
SPRINGER

Additional risk stratification may provide more aggressive and focalized preventive treatment to high-risk hypertensive patients according to the Japanese hypertension guidelines. We prospectively investigated the predictive value of high-sensitivity troponin I (hsTnI), both independently and in combination with N-terminal pro-B-type natriuretic peptide (NT-proBNP), for incident heart failure (HF) in high-risk hypertensive patients with preserved left ventricular ejection fraction (LVEF). Baseline hsTnI and NT-proBNP levels and echocardiography data were obtained for 493 Japanese hypertensive outpatients (mean age, 68.5 years) with LVEF ae<yen> 50%, no symptomatic HF, and at least one of the following comorbidities: stage 3-4 chronic kidney disease, diabetes mellitus, and stable coronary artery disease. During a mean follow-up period of 86.1 months, 44 HF admissions occurred, including 31 for HF with preserved ejection fraction (HFpEF) and 13 for HF with reduced ejection fraction (HFrEF; LVEF < 50%). Both hsTnI (p < 0.01) and NT-proBNP (p < 0.005) levels were significant independent predictors of HF admission. Furthermore, when the patients were stratified into 4 groups according to increased hsTnI (ae<yen>highest tertile value of 10.6 pg/ml) and/or increased NT-proBNP (ae<yen>highest tertile value of 239.7 pg/ml), the adjusted relative risks for patients with increased levels of both biomarkers versus neither biomarker were 13.5 for HF admission (p < 0.0001), 9.45 for HFpEF (p = 0.0009), and 23.2 for HFrEF (p = 0.003). Finally, the combined use of hsTnI and NT-proBNP enhanced the C-index (p < 0.05), net reclassification improvement (p = 0.0001), and integrated discrimination improvement (p < 0.05) to a greater extent than that of any single biomarker. The combination of hsTnI and NT-proBNP, which are individually independently predictive of HF admission, could improve predictions of incident HF in high-risk hypertensive patients but could not predict future HF phenotypes.

Link information
DOI
https://doi.org/10.1007/s00380-017-0948-9
Web of Science
https://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcAuth=JSTA_CEL&SrcApp=J_Gate_JST&DestLinkType=FullRecord&KeyUT=WOS:000404660400013&DestApp=WOS_CPL
ID information
  • DOI : 10.1007/s00380-017-0948-9
  • ISSN : 0910-8327
  • eISSN : 1615-2573
  • Web of Science ID : WOS:000404660400013

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