Prognostic Implications of N-Terminal Pro–B-Type Natriuretic Peptide and High-Sensitivity Cardiac Troponin T in EMPEROR-Preserved,JACC: Heart Failure

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Prognostic Implications of N-Terminal Pro–B-Type Natriuretic Peptide and High-Sensitivity Cardiac Troponin T in EMPEROR-Preserved
JACC: Heart Failure ( IF 10.3 ) Pub Date : 2022-06-01 , DOI: 10.1016/j.jchf.2022.05.004
James L Januzzi ₁ , Javed Butler ₂ , Faiez Zannad ₃ , Gerasimos Filippatos ₄ , João Pedro Ferreira ₅ , Stuart J Pocock ₆ , Naveed Sattar ₇ , Subodh Verma ₈ , Ola Vedin ₉ , Tomoko Iwata ₁₀ , Martina Brueckmann ₁₁ , Milton Packer ₁₂ , Stefan D Anker ₁₃ ,

Affiliation

Cardiology Division, Massachusetts General Hospital, Harvard Medical School, and Baim Institute for Clinical Research, Boston, Massachusetts, USA.
Department of Medicine, University of Mississippi School of Medicine, Jackson, Mississippi, USA.
Université de Lorraine, Inserm INI-CRCT, CHRU, Nancy, France.
National and Kapodistrian University of Athens School of Medicine, Athens University Hospital Attikon, Athens, Greece.
Université de Lorraine, Inserm, Centre d'Investigation Clinique Plurithématique, CHRU de Nancy, Nancy, France; Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal.
Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom.
BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom.
Division of Cardiac Surgery, St. Michael's Hospital and University of Toronto, Toronto, Ontario, Canada.
Boehringer-Ingelheim AB, Stockholm, Sweden.
Boehringer Ingelheim Pharma GmbH and Co KG, Biberach, Germany.
Boehringer Ingelheim International GmbH, Ingelheim, Germany; First Department of Medicine, Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, Germany.
Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, Texas, USA; Imperial College, London, United Kingdom.
Department of Cardiology (CVK), and the Berlin Institute of Health Center for Regenerative Therapies, German Centre for Cardiovascular Research Partner Site Berlin, Charité Universitätsmedizin, Berlin, Germany.

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 (HF) with preserved ejection fraction.

Objectives

The authors evaluated associations between both biomarkers and clinical outcomes in the EMPEROR-Preserved (Empagliflozin Outcome Trial in Patients with Chronic Heart Failure with Preserved Ejection Fraction) trial.

Methods

Of 5,988 study participants, 5,986 (99.9%) and 5,825 (97.3%) had available baseline NT-proBNP and hs-cTnT; postbaseline 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 were 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- to 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 cardiovascular 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 HF with preserved ejection fraction. (EMPagliflozin outcomE tRial in Patients With chrOnic heaRt Failure With Preserved Ejection Fraction [EMPEROR-Preserved]; NCT03057951)

中文翻译：

N 末端 Pro-B 型利钠肽和高灵敏度心肌肌钙蛋白 T 在 EMPEROR-Preserved 中的预后意义

背景

N 末端 B 型利钠肽前体 (NT-proBNP) 和高敏心肌肌钙蛋白 T (hs-cTnT) 与射血分数保留的心力衰竭 (HF) 患者的疾病严重程度和预后相关。

目标

作者在 EMPEROR-Preserved（保留射血分数的慢性心力衰竭患者的恩格列净结果试验）试验中评估了生物标志物和临床结果之间的关联。

方法

在 5,988 名研究参与者中，5,986 名（99.9%）和 5,825 名（97.3%）有可用的基线 NT-proBNP 和 hs-cTnT；基线后 NT-proBNP 也可用。基线特征由生物标志物四分位数表示。恩格列净对心血管死亡/心衰住院、个体成分、心衰住院总人数、估计肾小球滤过率 (eGFR) 下降斜率和复合肾脏终点的影响在生物标志物四分位数上进行了检查。还评估了作为治疗分配函数的研究访问中 NT-proBNP 的变化。

结果

较高的基线 NT-proBNP 和 hs-cTnT 浓度与更多的合并症和更严重的 HF 严重性相关。在最高与最低 NT-proBNP 或 hs-cTnT 四分位数中，心脏和肾脏结局的发生率高出 2 至 5 倍。Empagliflozin 持续降低心血管事件的风险，并降低 NT-proBNP 或 hs-cTnT 四分位数的 eGFR 下降斜率。Empagliflozin 治疗适度降低 NT-proBNP；到 100 周时，NT-proBNP 与安慰剂的调整后平均差异为 7%。NT-proBNP 从基线到 12 周的增加与心血管死亡/心衰住院的风险密切相关。

结论

恩格列净对心脏结局和 eGFR 下降的益处在广泛的基线 NT-proBNP 和 hs-cTnT 评估中得以保留。Empagliflozin 适度降低射血分数保留的 HF 中的 NT-proBNP。（EMPagliflozin 在保留射血分数的慢性心力衰竭患者中的结果试验 [EMPEROR-Preserved]；NCT03057951）

更新日期：2022-06-01

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