Prognostic Implications of N-terminal Pro-B Type Natriuretic Peptide and High-Sensitivity Cardiac Troponin T in EMPEROR-Preserved - Université de Lorraine Access content directly
Journal Articles JACC: Heart Failure Year : 2022

Prognostic Implications of N-terminal Pro-B Type Natriuretic Peptide and High-Sensitivity Cardiac Troponin T in EMPEROR-Preserved

Abstract

Background: N-terminal pro-B type natriuretic peptide (NT-proBNP) and high-sensitivity cardiac troponin T (hs-cTnT) are associated with disease severity and outcomes among patients with heart failure with preserved ejection fraction (HFpEF). Objectives: We evaluated associations between both biomarkers and clinical outcomes in the Empagliflozin Outcome Trial in Patients with Chronic Heart Failure with Preserved Ejection Fraction (EMPEROR-Preserved) Trial. Methods: Of 5988 study participants, 5986 (99.9%) and 5825 (97.3%) had available baseline NT-proBNP and hs-cTnT; post-baseline NT-proBNP was also available. Baseline characteristics were expressed by biomarker quartiles. The effect of empagliflozin on cardiovascular death/HF hospitalization, the individual components, total HF hospitalizations, slope of decline of estimated glomerular filtration rate (eGFR) and a composite renal endpoint was examined across biomarker quartiles. Change in NT-proBNP across study visits as a function of treatment assignment was also assessed. Results: Higher baseline NT-proBNP and hs-cTnT concentrations were associated with more comorbidities and worse HF severity. Incidence rates for cardiac and renal outcomes were 2-5-fold higher among those in the highest vs lowest NT-proBNP or hs-cTnT quartiles. Empagliflozin consistently reduced the risk for cardiovascular events and reduced slope of eGFR decline across NT-proBNP or hs-cTnT quartiles. Empagliflozin treatment modestly lowered NT-proBNP; by 100 weeks the adjusted mean difference in NT-proBNP from placebo was 7%. Increase in NT-proBNP from baseline to 12-weeks was strongly associated with risk of CV death/HF hospitalization. Conclusions: The benefit of empagliflozin on cardiac outcomes and decline of eGFR is preserved across the wide range of baseline NT-proBNP and hs-cTnT evaluated. Empagliflozin modestly reduces NT-proBNP in HFpEF.
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hal-03693416 , version 1 (10-06-2022)

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James Januzzi, Javed Butler, Faiez Zannad, Gerasimos Filippatos, João Pedro Ferreira, et al.. Prognostic Implications of N-terminal Pro-B Type Natriuretic Peptide and High-Sensitivity Cardiac Troponin T in EMPEROR-Preserved. JACC: Heart Failure, In press, 10 (7), pp.512-524. ⟨10.1016/j.jchf.2022.05.004⟩. ⟨hal-03693416⟩
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