1. The prognostic value of troponin T and N-terminal pro B-type natriuretic peptide, alone and in combination, in heart failure patients with and without diabetes.
- Author
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Rørth, Rasmus, Jhund, Pardeep S., Kristensen, Søren L., Desai, Akshay S., Køber, Lars, Rouleau, Jean L., Solomon, Scott D., Swedberg, Karl, Zile, Michael R., Packer, Milton, and McMurray, John J.V.
- Subjects
BRAIN natriuretic factor ,HEART failure ,HEART ,TYPE 2 diabetes complications ,DISEASES ,LONGITUDINAL method ,TYPE 2 diabetes ,PEPTIDE hormones ,PEPTIDES ,PROGNOSIS ,TROPONIN ,STROKE volume (Cardiac output) ,DISEASE complications - Abstract
Aims: We examined the prognostic importance of N-terminal pro B-type natriuretic peptide (NT-proBNP) and troponin T (TnT) in heart failure patients with and without diabetes.Methods and Results: We measured NT-proBNP and TnT in the biomarker substudy of the Prospective Comparison of ARNI With ACEI to Determine Impact on Global Mortality and Morbidity in Heart Failure trial (PARADIGM-HF). Of 1907 patients, 759 (40%) had diabetes. Median TnT in patients with diabetes was 18 (interquartile range 11-27) ng/L and 13 (9-21) ng/L in those without (P < 0.001). The TnT frequency-distribution curve was shifted to the right in patients with diabetes, compared to those without diabetes. By contrast, NT-proBNP did not differ between patients with and without diabetes. Diabetes and each biomarker were predictive of worse outcomes. Thus, patients with diabetes, an elevated TnT and a NT-proBNP level in the highest tertile (9% of all patients) had an absolute risk of cardiovascular death or heart failure hospitalization of 265 per 1000 person-years, compared to a rate of 42 per 1000 person-years in those without diabetes, a TnT < 18 ng/L and a NT-proBNP in the lowest tertile (16% of all patients). TnT remained an independent predictor of adverse outcomes in multivariable analyses including NT-proBNP.Conclusion: TnT is elevated to a greater extent in heart failure patients with diabetes compared to those without (whereas NT-proBNP is not). TnT and NT-proBNP are additive in predicting risk and when combined help identify diabetes patients at extremely high absolute risk. [ABSTRACT FROM AUTHOR]- Published
- 2019
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