Predictive Value of Serum N-Terminal pro-B-Type Natriuretic Peptide and Troponin T for Incident Heart Failure: A Meta-Analysis of 9 International Cohorts

TY - JOUR

T1 - Predictive Value of Serum N-Terminal pro-B-Type Natriuretic Peptide and Troponin T for Incident Heart Failure

T2 - A Meta-Analysis of 9 International Cohorts

AU - Bansal, Nisha

AU - Grams, Morgan E.

AU - Coresh, Josef

AU - Matsushita, Kunihiro

AU - Ballew, Shoshana H.

AU - Sang, Yingying

AU - Surapaneni, Aditya

AU - Ärnlöv, Johan

AU - Bell, Samira

AU - Berry, Jarett D.

AU - Damman, Kevin

AU - de Lemos, James A.

AU - Dobre, Mirela

AU - Hwang, Shih-Jen

AU - Gansevoort, Ron T.

AU - Shlipak, Michael G.

AU - Schneider, Markus P.

N1 - Publisher Copyright: © 2025 The Author(s). Published on behalf of the American Heart Association, Inc., by Wiley. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

PY - 2025/11/4

Y1 - 2025/11/4

N2 - BACKGROUND: Prior prediction equations for heart failure (HF) omitted cardiac biomarkers and used select populations. We assessed the added value of NT-proBNP (NT-terminal pro-brain natriuretic peptide) and hsTnT (high-sensitivity troponin T) as predictors of HF, across a broad population, including participants with chronic kidney disease or atherosclerotic cardiovascular disease. METHODS: Among 41427 individuals free of HF from 9 prospective cohort studies, we performed an individual-participant data meta-analysis, quantifying the associations of NT-proBNP and hsTnT with incident HF when added to a clinical model. Changes in Harrel’s C-statistic with and without NT-proBNP or hsTnT were estimated within each cohort and then pooled using random effects meta-analysis. RESULTS: Over a mean of 11years, 4599 incident HFs occurred. A 2-fold higher NT-proBNP was associated with incident HF (meta-analyzed hazard ratio [HR], 1.47 [95% CI, 1.38–1.56]), P<0.001, with no interaction between NT-proBNP and estimated glomerular filtration rate (HR, 0.97 [95% CI, 0.94–1.02], P=0.33) or atherosclerotic cardiovascular disease (HR, 0.97 [95% CI, 0.93–1.02], P=0.48). Adding NT-proBNP significantly increased the C-statistic by 0.030 (95% CI, 0.021–0.040, P<0.001) over the clinical model. Similar results were seen for hsTnT [meta-analyzed HR per 2-fold higher hsTnT 1.41 (95% CI, 1.30–1.54), P<0.001], but C-statistic increased by only 0.008 (95% CI, 0.005–0.011, P<0.001). In models that included NT-proBNP, addition of hsTnT had a smaller effect (change in C-statistic, 0.002 [95% CI, 0.001–0.003], P<0.001). CONCLUSIONS: NT-proBNP improved risk discrimination of incident HF when added to traditional HF risk factors, even in individuals with chronic kidney disease and atherosclerotic cardiovascular disease. The contribution of hsTnT was modest. Measurement of NT-proBNP may help identify individuals at risk of HF.

AB - BACKGROUND: Prior prediction equations for heart failure (HF) omitted cardiac biomarkers and used select populations. We assessed the added value of NT-proBNP (NT-terminal pro-brain natriuretic peptide) and hsTnT (high-sensitivity troponin T) as predictors of HF, across a broad population, including participants with chronic kidney disease or atherosclerotic cardiovascular disease. METHODS: Among 41427 individuals free of HF from 9 prospective cohort studies, we performed an individual-participant data meta-analysis, quantifying the associations of NT-proBNP and hsTnT with incident HF when added to a clinical model. Changes in Harrel’s C-statistic with and without NT-proBNP or hsTnT were estimated within each cohort and then pooled using random effects meta-analysis. RESULTS: Over a mean of 11years, 4599 incident HFs occurred. A 2-fold higher NT-proBNP was associated with incident HF (meta-analyzed hazard ratio [HR], 1.47 [95% CI, 1.38–1.56]), P<0.001, with no interaction between NT-proBNP and estimated glomerular filtration rate (HR, 0.97 [95% CI, 0.94–1.02], P=0.33) or atherosclerotic cardiovascular disease (HR, 0.97 [95% CI, 0.93–1.02], P=0.48). Adding NT-proBNP significantly increased the C-statistic by 0.030 (95% CI, 0.021–0.040, P<0.001) over the clinical model. Similar results were seen for hsTnT [meta-analyzed HR per 2-fold higher hsTnT 1.41 (95% CI, 1.30–1.54), P<0.001], but C-statistic increased by only 0.008 (95% CI, 0.005–0.011, P<0.001). In models that included NT-proBNP, addition of hsTnT had a smaller effect (change in C-statistic, 0.002 [95% CI, 0.001–0.003], P<0.001). CONCLUSIONS: NT-proBNP improved risk discrimination of incident HF when added to traditional HF risk factors, even in individuals with chronic kidney disease and atherosclerotic cardiovascular disease. The contribution of hsTnT was modest. Measurement of NT-proBNP may help identify individuals at risk of HF.

KW - atherosclerotic cardiovascular disease

KW - chronic kidney disease

KW - heart failure

KW - NT-proBNP

KW - troponin T

UR - https://www.scopus.com/pages/publications/105021063872

U2 - 10.1161/JAHA.125.041683

DO - 10.1161/JAHA.125.041683

M3 - Article

C2 - 41168946

VL - 14

JO - Journal of the American Heart Association

JF - Journal of the American Heart Association

IS - 21

M1 - e041683

ER -