Steady-State Levels of Troponin and Brain Natriuretic Peptide for Prediction of Long-Term Outcome after Acute Heart Failure with or without Stage 3 to 4 Chronic Kidney Disease

Abstract

Aim: To determine whether assessment of a combination of steady-state discharge levels of biomarkers improves risk stratification after acute decompensate HF. Study Design: Retrospective cohort study. Place and Duration of Study: Keio University Hospital, between January 2006 and September 2011. We analyzed 244 patients with acute HF due to ischemic or dilated cardiomyopathy who were enrolled in a prospective, single institution-based registry between January 2006 and September 2011. Patients were stratified by discharge values of BNP and/or TnT. The primary endpoint was a composite of HF readmission or death during the 2-year period after discharge. Results: The population was predominantly male (69.3%), and the mean age was 66.6±15.3 years. Patients with higher BNP levels or detectable TnT had a worse prognosis (BNP45.0% vs. 18.8%, p<0.001; TnT 43.8% vs. 25.1%, p=0.002, respectively). The primary event rate was additively worse among patients with both increased BNP levels and detectable TnT compared to those with increased levels of BNP or detectable TnT alone (log-rank p<0.001). A similar trend was observed in the subgroup of patients with CKD stage III–V (n=172). Conclusion: Assessment of both BNP and TnT values may have a significant predictive value for HF prognosis, even among patients with CKD, a condition affecting biomarker levels.