Background:
Hypertension is one of the most prevalent cardiovascular diseases and one of the most important causes of heart failure (HF) with preserved left ventricular ejection fraction (LVEF). We prospectively investigated the incremental predictive value of a combination of N-terminal pro-B-type natriuretic peptide (NT-proBNP), high-sensitivity troponin T (hsTnT), and galectin-3 for HF admission in outpatients with hypertension.
Methods:
Baseline serum NT-proBNP, hsTnT, and galectin-3 levels were measured in 443 outpatients (mean age, 69.4 years) with hypertension and LVEF ≥ 50%. Using tissue Doppler echocardiography, E/e’ ratio was calculated. Among these patients, 34% had a history of cardiovascular disease, and 46% had a history of diabetes.
Results:
Galectin-3 levels significantly (p < 0.0001) correlated with E/e’ ratio (r = 0.21) and estimated glomerular filtration rate (eGFR; r = –0.78). During a mean follow-up period of 899 days, there were 40 (9%) HF admissions. Using multivariate Cox regression analysis including 10 clinical, biochemical, and echocardiographic variables, increased NT-proBNP (relative risk, 2.88 per 10-fold increment, p = 0.007) and hsTnT (4.30 per 10-fold increment, p = 0.004) levels, but not ga1ectin-3 levels, were shown to be independent predictors of HF admission. When patients were stratified into four groups according to NT-proBNP levels ≥ a median value of 193.7 pg/mL and/or hsTnT levels ≥ a median value of 14 pg/mL, HF admission rates were 1.1%, 2.1%, 4.3%, and 20%, respectively (p < 0.0001). Furthermore, when NT-proBNP and hsTnT levels were combined, the predictive values for HF admission were increased, as shown by the C-index, net reclassification improvement (NRI), and integrated discrimination improvement (IDI; Table 1).
Conclusions:
The combined assessment of NT-proBNP and hsTnT levels can improve the prediction of HF admission in outpatients with hypertension.
Soluble ST2, high-sensitivity troponin T- and N-terminal pro-B-type natriuretic peptide: complementary role for risk stratification in acutely decompensated heart failure
