{
  "abstract": "Background\n\nHigh-sensitivity cardiac troponin T (hs-cTnT) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) are widely used in heart failure (HF), but outpatient interpretation often depends on isolated values rather than within-person change. We evaluated a pragmatic dual-biomarker delta-check framework for 12-month risk stratification in chronic HF.Methods\n\nWe performed a retrospective cohort study of adults with chronic HF who had paired hs-cTnT and NT-proBNP measurements obtained during a clinically stable anchor visit and repeated within 3-6 months. The second paired measurement served as the index date. Patients were classified a priori into Green, Yellow, or Red trajectory tiers using combined relative and absolute biomarker changes, interpreted with a minimum clinical context bundle including rhythm, renal function, and clinical state. Meaningful adverse change was defined as hs-cTnT rise ≥ 20% and ≥ 5 ng/L, and NT-proBNP rise ≥ 30% and ≥ 500 pg/mL, or ≥ 300 pg/mL when anchor NT-proBNP was < 1,000 pg/mL. The primary endpoint was HF hospitalization or all-cause death within 12 months.Results\n\nAmong 520 patients, 229 (44%) were Green, 187 (36%) Yellow, and 104 (20%) Red. Anchor median NT-proBNP was 1,850 pg/mL [780-4,400], and hs-cTnT was 21 ng/L [13-36]. The primary endpoint occurred in 140 patients (26.9%). Event rates increased stepwise across tiers: Green 17.9%, Yellow 27.8%, and Red 45.2% (log-rank p < 0.001). In adjusted Cox models, Yellow showed an intermediate signal (HR 1.4, 95% CI 1.0-2.0; p = 0.06), whereas Red remained independently associated with higher risk (HR 2.1, 95% CI 1.4-3.2; p < 0.001). In a sensitivity model excluding anchor hs-cTnT and anchor NT-proBNP, the associations were preserved: Yellow HR 1.5 (95% CI 1.1-2.2; p = 0.03) and Red HR 2.5 (95% CI 1.7-3.6; p < 0.001).Conclusions\n\nA pragmatic hs-cTnT/NT-proBNP delta-check stratified 12-month risk in chronic HF. Concordant worsening across both biomarkers identified a high-risk trajectory, while isolated or borderline change was best interpreted as a lower-intensity review signal. Prospective testing is needed before this framework is used to guide outcome-modifying interventions.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Adult Cardiology, National Heart Center, The Royal Hospital, Muscat, Oman. dr.albulushi@gmail.com.",
    "Advanced Heart Failure & Transplant Cardiology, National Heart Center, The Royal Hospital, Muscat, Oman. dr.albulushi@gmail.com.",
    "Department of Adult Cardiology, National Heart Center, The Royal Hospital, Muscat, Oman.",
    "Department of Medicine, Sultan Qaboos University Hospital, Muscat, Oman."
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 3,
  "authors": [
    {
      "affs": [
        0,
        1
      ],
      "name": "Arif Albulushi",
      "orcid": "0000-0002-7030-1816"
    },
    {
      "affs": [
        2
      ],
      "name": "Gamal Aly"
    },
    {
      "affs": [
        3
      ],
      "name": "Hatem Al-Farhan"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/96w14eajyp1z6.bib",
  "cited_by": 0,
  "doi": "10.1186/s12872-026-06344-0",
  "fulltext_url": "https://europepmc.org/articles/PMC13689186",
  "id": "96w14eajyp1z6",
  "issns": [
    "1471-2261"
  ],
  "landing_url": "https://europepmc.org/article/MED/42907778",
  "language": "eng",
  "licence": "CC-BY-NC-ND",
  "licence_label": "CC BY-NC-ND",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "lcc",
      "RC666-701"
    ],
    [
      "openalex",
      "2705|Heart Failure Treatment and Management"
    ]
  ],
  "openalex": "W7171386431",
  "pdf_url": "https://europepmc.org/articles/PMC13689186?pdf=render",
  "pmcid": "PMC13689186",
  "pmid": "42907778",
  "published": "2026-07-01",
  "publisher": "BMC",
  "ris": "https://research.draconitic.com/paper/96w14eajyp1z6.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:19:57Z",
      "native_id": "MED:42907778",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42907778"
    },
    {
      "first_seen": "2026-10-30T13:45:36Z",
      "native_id": "9815afeac5c64f068d656800711b909e",
      "source": "doaj",
      "url": "https://doi.org/10.1186/s12872-026-06344-0"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2705|Heart Failure Treatment and Management",
      "subfield": "cardiovascular"
    }
  ],
  "title": "From numbers to trajectories: a pragmatic hs-cTnT/NT-proBNP delta-check for 12-month risk stratification in chronic heart failure.",
  "title_text": "From numbers to trajectories: a pragmatic hs-cTnT/NT-proBNP delta-check for 12-month risk stratification in chronic heart failure.",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T13:45:36Z",
  "url": "https://research.draconitic.com/paper/96w14eajyp1z6",
  "venue": "BMC cardiovascular disorders",
  "versions": []
}