Salivary and serum levels of NT-proBNP, troponin, and high-sensitivity C-reactive protein in patients with heart failure
5 affiliations
- 1Department of Medicine, University of Taubaté, Taubaté, São Paulo, Brazil
- 2Department of Dentistry, University of Taubaté, Taubaté, São Paulo, Brazil
- 3Department of Clinical Sciences, Pathology, and Surgery, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- 4School of Nursing and Public Health, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
- 5CEEpiRG - Center for Epigenetic Study and Genic Regulation, Program in Environmental and Experimental Pathology, Paulista University, São Paulo, São Paulo, Brazil
Abstract
Background: Saliva has been proposed as a non-invasive biological matrix for cardiovascular biomarker assessment. However, evidence regarding its agreement with blood-based measurements in patients with heart failure remains inconsistent. Objective: To assess the presence of NT-proBNP, troponin, and high-sensitivity C-reactive protein in saliva and their correlation with serum concentrations in patients with heart failure over a six-month follow-up period. Methods: Participants were prospectively evaluated, and paired saliva and blood samples were collected at baseline, 3 and 6 months. The population included 52 individuals (30 males and 22 females) with HFmrEF (LVEF 41–49%) or HFrEF (LVEF ≤40%), aged 49–80 years (mean age of 61.1 ± 6.79 years). Biomarker concentrations were measured in both matrices. Agreement between salivary and serum measurements was assessed using Bland–Altman analysis. Additional analyses explored whether age influenced the relationship between salivary and serum biomarker levels. Results: All three biomarkers were consistently detectable in whole saliva. However, Bland–Altman analyses showed that salivary NT-proBNP and troponin did not demonstrate clinically acceptable agreement with serum concentrations at any evaluated time point, indicating limited interchangeability between matrices. In contrast, hs-CRP exhibited relatively better agreement between saliva and serum, with mean bias close to zero and moderate limits of agreement, although substantial inter-individual variability persisted. Age and sex did not meaningfully influence the relationship between salivary and serum biomarker concentrations. Conclusions: Although NT-proBNP, troponin, and hs-CRP are detectable in saliva, salivary measurements of NT-proBNP and troponin showed insufficient agreement with serum levels to support their use as substitutes for blood-based assessment in heart failure. hs-CRP demonstrated comparatively better performance but remains limited by variability. Under the conditions evaluated, serum remains the reference standard for cardiovascular biomarker assessment in heart failure, and saliva should be regarded as a matrix warranting further investigation.
Related
- Impact of High-sensitivity C-reactive protein testing on statin use in primary prevention: A national multicenter analysis
- High-Sensitivity Cardiac Troponin T and I Discordance in Patients Receiving Immune Checkpoint Inhibitors
- High-sensitivity troponin T as a predictor of cardiovascular events in colorectal cancer patients undergoing chemotherapy: results of the COLOVASC prospective cohort study
- Cost-effectiveness of prehospital high-sensitivity troponin i testing versus standard emergency department care in patients with suspected acute coronary syndrome in France
- High-sensitivity C-reactive protein profiles differ between Korean and US adults with LDL cholesterol below 100 mg/dL
BibTeX
@article{viegas2026salivary,
title = {{Salivary and serum levels of NT-proBNP, troponin, and high-sensitivity C-reactive protein in patients with heart failure}},
author = {Ruy Felipe Melo Viegas and Sheila Cavalca Cortelli and Davi Romeiro Aquino and Fernando Oliveira Costa and Bruna Hentges and Vitórya Carvalho Pádua de Magalhães and Rodrigo Augusto Foganholi Silva and Gilson Fernandes Ruivo and Jose Roberto Cortelli},
journal = {PLOS One},
year = {2026},
month = sep,
doi = {10.1371/journal.pone.0357206},
url = {https://doi.org/10.1371/journal.pone.0357206},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Salivary and serum levels of NT-proBNP, troponin, and high-sensitivity C-reactive protein in patients with heart failure
AU - Ruy Felipe Melo Viegas
AU - Sheila Cavalca Cortelli
AU - Davi Romeiro Aquino
AU - Fernando Oliveira Costa
AU - Bruna Hentges
AU - Vitórya Carvalho Pádua de Magalhães
AU - Rodrigo Augusto Foganholi Silva
AU - Gilson Fernandes Ruivo
AU - Jose Roberto Cortelli
PY - 2026
DA - 2026/09/18
JO - PLOS One
DO - 10.1371/journal.pone.0357206
UR - https://doi.org/10.1371/journal.pone.0357206
AB - Background: Saliva has been proposed as a non-invasive biological matrix for cardiovascular biomarker assessment. However, evidence regarding its agreement with blood-based measurements in patients with heart failure remains inconsistent. Objective: To assess the presence of NT-proBNP, troponin, and high-sensitivity C-reactive protein in saliva and their correlation with serum concentrations in patients with heart failure over a six-month follow-up period. Methods: Participants were prospectively evaluated, and paired saliva and blood samples were collected at baseline, 3 and 6 months. The population included 52 individuals (30 males and 22 females) with HFmrEF (LVEF 41–49%) or HFrEF (LVEF ≤40%), aged 49–80 years (mean age of 61.1 ± 6.79 years). Biomarker concentrations were measured in both matrices. Agreement between salivary and serum measurements was assessed using Bland–Altman analysis. Additional analyses explored whether age influenced the relationship between salivary and serum biomarker levels. Results: All three biomarkers were consistently detectable in whole saliva. However, Bland–Altman analyses showed that salivary NT-proBNP and troponin did not demonstrate clinically acceptable agreement with serum concentrations at any evaluated time point, indicating limited interchangeability between matrices. In contrast, hs-CRP exhibited relatively better agreement between saliva and serum, with mean bias close to zero and moderate limits of agreement, although substantial inter-individual variability persisted. Age and sex did not meaningfully influence the relationship between salivary and serum biomarker concentrations. Conclusions: Although NT-proBNP, troponin, and hs-CRP are detectable in saliva, salivary measurements of NT-proBNP and troponin showed insufficient agreement with serum levels to support their use as substitutes for blood-based assessment in heart failure. hs-CRP demonstrated comparatively better performance but remains limited by variability. Under the conditions evaluated, serum remains the reference standard for cardiovascular biomarker assessment in heart failure, and saliva should be regarded as a matrix warranting further investigation.
SN - 1932-6203
ER -