N-terminal Pro B-Type Natriuretic Peptide (NT-proBNP), Troponin T, and Incident Heart Failure: The Chronic Kidney Disease Prognosis Consortium

Background: Recently, the American Heart Association PREVENT equation was developed to predict 10-year risk of incident heart failure (HF) in persons without prevalent atherosclerotic cardiovascular disease (ASCVD), incorporating eGFR and albuminuria. We aimed to determine the added value of NTproBNP and troponin T (TnT) as predictors of HF in the ambulatory setting, across a broad range of cohorts and including participants with prevalent ASCVD. Methods: We performed individual-participant data meta-analysis of 38,274 individuals without a history of HF. Adjusted Cox models were used to quantify the associations of NT-pro-BNP and troponin T with HF after adjusting for variables in the PREVENT model, and to assess whether the associations varied by age and CKD status. Results: There were 3,990 incident HF events over a mean of 12 years. In meta-analysis, a 2-fold higher NTproBNP was associated with 1.47-fold (95% CI: 1.37-1.59) higher risk of HF. The association between NTproBNP and HF was stronger in older age but not different by GFR. The increase in C-statistic was 0.029 (0.018, 0.040) over the base model and was greater among older (0.044, 95% CI: 0.030, 0.059) than younger adults (0.024, 95% CI: 0.010, 0.038). For TnT, a 2-fold higher value was associated with 1.45-fold (95% CI: 1.33-1.57) higher risk of HF, but the increase in C-statistic was smaller (0.009, 95% CI: 0.006, 0.012). Adding TnT to a model with NTproBNP resulted in minimal increment in c-statistic (0.002, 95% CI: 0.001, 0.004). Conclusion: NTproBNP adds robust information to the PREVENT model for discrimination of HF risk, particularly among older adults. Funding: NIDDK Support, Private Foundation Support