From numbers to trajectories: a pragmatic hs-cTnT/NT-proBNP delta-check for 12-month risk stratification in chronic heart failure.
4 affiliations
- 1Department of Adult Cardiology, National Heart Center, The Royal Hospital, Muscat, Oman. [email protected].
- 2Advanced Heart Failure & Transplant Cardiology, National Heart Center, The Royal Hospital, Muscat, Oman. [email protected].
- 3Department of Adult Cardiology, National Heart Center, The Royal Hospital, Muscat, Oman.
- 4Department of Medicine, Sultan Qaboos University Hospital, Muscat, Oman.
Abstract
Background
High-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
We 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
Among 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
A 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.
Related
- Longitudinal trajectories of kinesiophobia and associated factors in patients with chronic heart failure
- TeleBACK clinical trial: comparing the effectiveness of telerehabilitation and in-clinic physical therapy for patients with chronic low back pain - protocol for a multicentre, pragmatic, individually randomised group treatment trial.
- Risk stratification of Stage B heart failure with BNP levels of 35–100 pg/mL: development of the PHASE Index from the CHART-2 Study
- Cost impact of chronic care management services in a large multi-specialty practice: A pragmatic outcomes study
- Longitudinal Trajectories of Hospitalizations in U.S. Older Adults with Heart Failure
BibTeX
@article{albulushi2026from,
title = {{From numbers to trajectories: a pragmatic hs-cTnT/NT-proBNP delta-check for 12-month risk stratification in chronic heart failure.}},
author = {Arif Albulushi and Gamal Aly and Hatem Al-Farhan},
journal = {BMC cardiovascular disorders},
year = {2026},
month = jul,
doi = {10.1186/s12872-026-06344-0},
url = {https://europepmc.org/article/MED/42907778},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - From numbers to trajectories: a pragmatic hs-cTnT/NT-proBNP delta-check for 12-month risk stratification in chronic heart failure.
AU - Arif Albulushi
AU - Gamal Aly
AU - Hatem Al-Farhan
PY - 2026
DA - 2026/07/01
JO - BMC cardiovascular disorders
DO - 10.1186/s12872-026-06344-0
UR - https://europepmc.org/article/MED/42907778
AB - Background High-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 We 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 Among 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 A 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.
SN - 1471-2261
ER -