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Heart and Vessels
Published in: Heart and Vessels 7/2017

01-07-2017 | Original Article

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

Authors: 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

Published in: Heart and Vessels | Issue 7/2017

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Abstract

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 ≥ 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 (≥highest tertile value of 10.6 pg/ml) and/or increased NT-proBNP (≥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.
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Metadata
Title
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
Authors
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
Publication date
01-07-2017
Publisher
Springer Japan
Published in
Heart and Vessels / Issue 7/2017
Print ISSN: 0910-8327
Electronic ISSN: 1615-2573
DOI
https://doi.org/10.1007/s00380-017-0948-9

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