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

Bansal N, Grams ME, Coresh J, Matsushita K, Ballew SH, Sang Y, Surapaneni A, Ärnlöv J, Bell S, Berry JD, Damman K, de Lemos JA, Dobre M, Hwang SJ, Gansevoort RT, Shlipak MG, Schneider M (2025)

Publication Type: Journal article

Publication year: 2025

Journal

Journal of the American Heart Association Wiley

Book Volume: 14

Article Number: e041683

Journal Issue: 21

DOI: 10.1161/JAHA.125.041683

Abstract

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.

Authors with CRIS profile

Markus Schneider Department of Medicine 4 – Nephrology and Hypertension

Involved external institutions

University of Washington US United States (USA) (US) New York University (NYU) US United States (USA) (US) Johns Hopkins University (JHU) US United States (USA) (US) Dalarna University / Högskolan Dalarna SE Sweden (SE) University of Dundee GB United Kingdom (GB) The University of Texas at Tyler (UTT) US United States (USA) (US) University Medical Center Groningen (UMCG) / Universitair Medisch Centrum Groningen NL Netherlands (NL) University of Texas Southwestern Medical Center (UT Southwestern) US United States (USA) (US) University Hospitals of Cleveland / Case Western Reserve University Hospital US United States (USA) (US) Framingham Heart Study US United States (USA) (US) University of California San Francisco (UCSF) US United States (USA) (US)

How to cite

APA:

Bansal, N., Grams, M.E., Coresh, J., Matsushita, K., Ballew, S.H., Sang, Y.,... Schneider, M. (2025). 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. Journal of the American Heart Association, 14(21). https://doi.org/10.1161/JAHA.125.041683

MLA:

Bansal, Nisha, et al. "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." Journal of the American Heart Association 14.21 (2025).

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