Comparison of prognostic values of high-sensitivity cardiac troponin T and N-terminal prohormone brain natriuretic peptide to assess mortality in elderly inpatients

Figures & data

Table 1 Clinical characteristics of the study population by tertiles of NT-proBNP

	Tertile 1 (low), ≤130.4 pg/mL (n=236)	Tertile 2 (middle), 130.40–631.06 pg/mL (n=243)	Tertile 3 (high), ≥631.06 pg/mL (n=236)	P-value*
Baseline
Age, years	80.03±6.14	83.04±5.51	84.14±5.56	<0.001
Male sex, %	167 (70.8)	150 (61.7)	153 (64.8)	0.11
Body-mass index, kg/m^2	23.96±3.10	23.38±3.22	23.39±3.51	0.087
Heart rate, beats/min	72.25±11.57	73.55±12.37	75.79±14.58	0.017
Systolic pressure, mmHg	130.83±16.45	130.98±15.13	130.50±17.03	0.95
Diastolic pressure, mmHg	71.07±8.81	70.64±9.00	69.66±9.11	0.25
Active smoking	21 (8.9)	16 (6.6)	20 (8.5)	0.61
Comorbidities
SCAD, n (%)	51 (21.6)	77 (31.7)	105 (44.5)	<0.001
Hypertension, n (%)	181 (76.7)	195 (80.3)	196 (83.1)	0.22
DM, n (%)	83 (35.2)	96 (39.5)	93 (39.4)	0.54
Cerebral infarction, n (%)	140 (59.3)	149 (61.3)	143 (60.6)	0.90
COPD, n (%)	43 (18.2)	43 (17.7)	52 (22.0)	0.43
CKD, n (%)	39 (16.5)	59 (24.3)	78 (33.1)	<0.001
AF, n (%)	20 (8.5)	32 (13.2)	54 (22.9)	<0.001
Biochemistry
TC, mmol/L	4.26±0.96	4.09±1.00	3.85±0.84	<0.001
TG, mmol/L	1.18 (0.84–1.64)	1.03 (0.77–1.40)	0.95 (0.76–1.28)	<0.001
HDL-C, mmol/L	1.26±0.38	1.29±0.42	1.21±0.38	0.057
LDL-C, mmol/L	2.56±0.79	2.41±0.84	2.25±0.68	<0.001
Hb, g/L	134.35±16.65	126.62±19.79	123.09±20.59	<0.001
ALT, mmol/L	15.20 (11.70–19.90)	14.50 (10.90–18.60)	13.25 (10.05–19.65)	0.058
eGFR	80.25±23.55	75.57±26.73	67.06±22.57	<0.001
Echocardiography
LVEF, %	59.97±2.84	59.58±4.11	57.66±5.38	<0.001
LVMI, g/m^2	121.38±23.70	127.53±28.89	132.57±29.74	<0.001

Note:

* ANOVA or Kruskal–Wallis test.

Abbreviations: AF, atrial fibrillation; CKD, chronic kidney disease; DM, diabetes mellitus; eGFR, estimated glomerular filtration rate; Hb, hemoglobin; HDL-C, high-density-lipoprotein cholesterol; LDL-C, low-density-lipoprotein cholesterol; LVEF, left ventricular ejection fraction; LVMI, left ventricular mass index; NT-proBNP, N-terminal prohormone brain natriuretic peptide; SCAD, stable coronary artery disease; TC, total cholesterol; TG, triglycerides.

Table 2 Clinical characteristics of the study population by tertiles of hs-cTnT

	Tertile 1 (low), ≤0.009 ng/mL (n=253)	Tertile 2 (middle), 0.009–0.020 ng/L (n=231)	Tertile 3 (high), ≥0.020 ng/L (n=231)	P-value
Baseline
Age, years	79.68±6.11	83.04±5.24	84.77±5.37	<0.001
Male sex, %	138 (54.6)	152 (65.8)	180 (77.9)	<0.001
Body-mass index, kg/m^2	23.36±3.30	23.62±3.30	23.77±3.27	0.38
Heart rate, beats/min	72.28±12.10	74.23±13.21	75.23±13.51	0.056
Systolic pressure, mmHg	131.44±16.02	129.82±16.78	130.99±15.81	0.53
Diastolic pressure, mmHg	70.33±8.58	71.15±9.17	69.87±9.21	0.34
Active smoking	21 (8.3)	18 (7.8)	18 (7.8)	0.97
Comorbidities
SCAD, n (%)	64 (25.3)	78 (33.8)	91 (39.4)	0.004
Hypertension, n (%)	190 (75.1)	182 (78.8)	200 (86.6)	0.006
DM, n (%)	76 (30.0)	97 (42.0)	99 (42.9)	0.005
Cerebral infarction, n (%)	144 (56.9)	136 (58.9)	152 (65.8)	0.11
COPD, n (%)	37 (14.6)	42 (18.2)	59 (25.5)	0.009
CKD, n (%)	43 (17.0)	49 (21.2)	84 (36.4)	<0.001
AF, n (%)	30 (11.9)	45 (19.5)	31 (13.4)	0.052
Biochemistry
TC, mmol/L	4.21±0.91	4.09±0.96	3.88±0.96	<0.001
TG, mmol/L	1.13 (0.83–1.56)	1.00 (0.78–1.38)	0.98 (0.74–1.35)	0.004
HDL-C, mmol/L	1.30±0.38	1.23±0.41	1.22±0.39	0.028
LDL-C, mmol/L	2.50±0.76	2.45±0.78	2.26±0.80	0.003
Hb, g/L	131.34±16.64	128.84±19.39	123.52±22.00	<0.001
ALT, mmol/L	14.75 (11.45–18.55)	14.10 (10.20–18.70)	14.40 (10.60–21.40)	0.54
eGFR	78.45±22.69	76.48±23.59	67.58±27.22	<0.001
Echocardiography
LVEF, %	59.92±3.35	59.33±3.95	57.90±5.35	<0.001
LVMI, g/m^2	121.15±24.46	127.98±27.95	132.95±29.81	<0.001

Abbreviations: AF, atrial fibrillation; CKD, chronic kidney disease; DM, diabetes mellitus; eGFR, estimated glomerular filtration rate; Hb, hemoglobin; HDL-C, high-density-lipoprotein cholesterol; hs-cTnT, high-sensitivity cardiac troponin T; LDL-C, low-density-lipoprotein cholesterol; LVEF, left ventricular ejection fraction; LVMI, left ventricular mass index; SCAD, stable coronary artery disease; TC, total cholesterol; TG, triglycerides.

Figure 1 Kaplan–Meier survival curves for mortality based on tertiles of baseline values of hs-cTnT and NT-proBNP.

Abbreviations: hs-cTnT, high-sensitivity cardiac troponin T; NT-proBNP, N-terminal prohormone brain natriuretic peptide.

Table 3 Cox proportional regression analysis for mortality

	Model 1	Model 2	Model 3	Model 4	Model 5
NT-proBNP, HR (95% CI)
Tertile 1	1.0 (reference)	1.0 (reference)	1.0 (reference)	1.0 (reference)	1.0 (reference)
Tertile 2	1.98 (1.16–3.38)	1.46 (0.85–2.51)	1.37 (0.80–2.35)	1.24 (0.70–2.18)	1.05 (0.60–1.88)
Tertile 3	4.13 (2.52–6.79)	2.76 (1.66–4.60)	2.55 (1.50–4.34)	2.17 (0.99–3.84)	1.77 (0.83–3.17)
hs-cTnT, HR (95% CI)
Tertile 1	1.0 (reference)	1.0 (reference)	1.0 (reference)	1.0 (reference)	1.0 (reference)
Tertile 2	2.66 (1.47–4.82)	1.99 (1.09–3.63)	1.86 (1.02–3.39)	1.69 (0.91–3.11)	1.63 (0.88–3.01)
Tertile 3	7.22 (4.23–12.34)	4.69 (2.66–8.24)	4.29 (2.43–7.56)	3.58 (2.02–6.35)	3.29 (1.85–5.85)

Notes: Model 1, univariate; model 2, adjusted for age and sex; model 3, adjusted for model 2 plus heart rate, CAD, CKD, AF, TC, TG, LDL-C, HDL-C, Hb, eGFR, DM, AF, COPD, and hypertension; model 4, adjusted for model 3 plus LVEF, LVMI; model 5, adjusted for model 4 plus hs-cTnT or NT-proBNP.

Abbreviations: AF, atrial fibrillation; CAD, coronary artery disease; CKD, chronic kidney disease; DM, diabetes mellitus; eGFR, estimated glomerular filtration rate; Hb, hemoglobin; HDL-C, high-density-lipoprotein cholesterol; hs-cTnT, high-sensitivity cardiac troponin T; LDL-C, low-density-lipoprotein cholesterol; LVEF, left ventricular ejection fraction; LVMI, left ventricular mass index; NT-proBNP, N-terminal prohormone brain natriuretic peptide; TC, total cholesterol; TG, triglycerides.

Figure 2 Receiver-operating characteristic curves for NT-proBNP and hs-cTnT.

Abbreviations: hs-cTnT, high-sensitivity cardiac troponin T; NT-proBNP, N-terminal prohormone brain natriuretic peptide.

Figure 3 Time-dependent receiver-operating characteristic curve analysis for hs-cTnT and NT-proBNP.

Note: iAUC values for mortality at 60 months (5 years) were 0.585 (95% CI 0.483–0.687) for NT-proBNP and 0.712 (95% CI 0.616–0.809) for hs-cTnT.
Abbreviations: hs-cTnT, high-sensitivity cardiac troponin T; iAUC, incremental area under curve; NT-proBNP, N-terminal prohormone brain natriuretic peptide.

Table 4 Mortality by tertiles of hs-cTnT and NT-proBNP when considered together

Tertile groups		HR (95% CI)
hs-cTnT	NT-proBNP
Low	Low	1.0 (reference)
Low	Median	0.79 (0.20–2.99)
Low	High	1.08 (0.31–3.75)
Median	Low	1.49 (0.43–5.26)
Median	Median	0.99 (0.31–3.14)
Median	High	3.01 (1.05–8.63)
High	Low	2.97 (0.94–9.42)
High	Median	3.62 (1.28–10.20)
High	High	3.36 (1.19–9.54)

Abbreviations: hs-cTnT, high-sensitivity cardiac troponin T; NT-proBNP, N-terminal prohormone brain natriuretic peptide.

Figure 4 Mortality based on the combination of hs-cTnT and NT-proBNP.

Abbreviations: hs-cTnT, high-sensitivity cardiac troponin T; NT-proBNP, N-terminal prohormone brain natriuretic peptide.