The impact of dynamic changes in N-terminal B-type natriuretic peptide precursor and high-sensitivity cardiac troponin T on the treatment outcomes of elderly patients with acute left heart failure

Chen Feifei; Lu Sujuan; Ye Danru; Hao Tianpao; Huang Enhui

doi:10.3969/j.issn.1002-1949.2025.11.010

Abstract：Objective To investigate the impact of dynamic changes in N-terminal B-type natriuretic peptide precursor(NT-proBNP)and high-sensitivity cardiac troponin T(hs-cTnT)on the treatment outcomes of elderly patients with acute left heart failure(ALHF).Methods A retrospective analysis was conducted on the clinical data of 298 elderly ALHF patients admitted to the First Affiliated Hospital of Wenzhou Medical University from March 2022 to February 2025.According to the patient's treatment outcome,they were divided into an improvement group(n=255)and a non-improvement group(n=43).The levels of serum NT-proBNP and hs-cTnT at admission,24 h and 48 h after admission were reviewed and statistically analyzed,and the changing trajectories of NT-proBNP and hs-cTnT were recorded.The effects of two indexes on the treatment outcome of elderly patients with ALHF were analyzed.Multivariate Logistic regression analysis was used to identify the influencing factors of treatment outcomes in elderly patients,and a column chart model was constructed based on this.The predictive value and calibration degree of the prediction model were evaluated by using receiver operating characteristic(ROC)curves and calibration curves.Results At 24 h and 48 h after admission,the serum levels of NT-proBNP and hs-cTnT in the non-improvement group were higher than those at admission(P＜0.05).At 48 h after admission,the levels of NT-proBNP and hs-cTnT in the improvement group were lower than those at admission,24 h after admission(P＜0.05).The serum levels of NT-proBNP and hs-cTnT in the non-improvement group were higher than those in the improvement group at admission,24 h and 48 h after admission(P＜0.05).The proportion of NT-proBNP and hs-cTnT double elevation within 48 h of admission in the non-improvement group was higher than that in the improvement group(P＜0.05).ROC curve analysis found the predictive value of serum NT-proBNP and hs-cTnT for treatment outcome in elderly patients with ALHF at 48 h after admission was the highest,with the areas under ROC curves(AUC)being 0.943 and 0.882,respectively.The results of Logistic regression analysis showed that double increase of NT-proBNP and hs-cTnT within 48 h of admission,age＞85 years old,combined cardiogenic shock,acute kidney injury(AKI),readmission due to acute heart failure(AHF),and elevated blood lactate were risk factors for the treatment outcome of elderly patients with ALHF(P＜0.05).Based on the above factors,the construction of a predictive model for predicting the treatment outcome of elderly patients with ALHF showed that this model had a high predictive value,with the AUC of 0.900,the sensitivity of 0.907 and the specificity of 0.769.The accurate curve indicated good consistency between the predicted probability of the prediction model and the actual probability.Conclusion The dynamic changing trajectories of serum NT-proBNP and hs-cTnT within 48 h after admission in elderly patients with ALHF are related to the treatment outcome.The simultaneous increase of NT-proBNP and hs-cTnT may increase the risk of ineffective treatment.A nomogram constructed based on the dynamic changing trajectories of NT-proBNP and hs-cTnT has predictive significance for the treatment outcome of elderly patients with ALHF.