The prognostic value of troponin T and N-terminal pro B-type natriuretic peptide, alone and in combination, in heart failure patients with and without diabetes

Aims We examined the prognostic importance of N‐terminal pro B‐type natriuretic peptide (NT‐proBNP) and troponin T (TnT) in heart failure patients with and without diabetes. Methods and results We measured NT‐proBNP and TnT in the biomarker substudy of the Prospective Comparison of ARNI With ACEI to Determine Impact on Global Mortality and Morbidity in Heart Failure trial (PARADIGM‐HF). Of 1907 patients, 759 (40%) had diabetes. Median TnT in patients with diabetes was 18 (interquartile range 11–27) ng/L and 13 (9–21) ng/L in those without (P < 0.001). The TnT frequency‐distribution curve was shifted to the right in patients with diabetes, compared to those without diabetes. By contrast, NT‐proBNP did not differ between patients with and without diabetes. Diabetes and each biomarker were predictive of worse outcomes. Thus, patients with diabetes, an elevated TnT and a NT‐proBNP level in the highest tertile (9% of all patients) had an absolute risk of cardiovascular death or heart failure hospitalization of 265 per 1000 person‐years, compared to a rate of 42 per 1000 person‐years in those without diabetes, a TnT < 18 ng/L and a NT‐proBNP in the lowest tertile (16% of all patients). TnT remained an independent predictor of adverse outcomes in multivariable analyses including NT‐proBNP. Conclusion TnT is elevated to a greater extent in heart failure patients with diabetes compared to those without (whereas NT‐proBNP is not). TnT and NT‐proBNP are additive in predicting risk and when combined help identify diabetes patients at extremely high absolute risk.