Iranian Heart Journal

Iranian Heart Journal

New Insights Into the Use of hs-cTnI and NT-proBNP in Chronic Coronary Syndromes

Document Type : Original Article

Authors
Moayed Basheer Hamid 1
Amal Abbas Hammoodi 2
Basil Oiel Saleh 2
Ameen Abdulhasan Al-Alwany 3
1 Department of Medicine, College of Medicine, Al-Nahrain University, Baghdad, Iraq.
2 Department of Biochemistry, College of Medicine, University of Baghdad, Baghdad, Iraq.
3 Department of Medicine, University of Baghdad, College of Medicine, Baghdad, Iraq.
Abstract
Background: A noninvasive method of determining the severity of coronary artery disease (CAD) is the use of cardiac biomarkers. This study aimed to investigate the use of serum levels of high-sensitivity cardiac troponin I (hs-cTnI) and N-terminal pro–B-type natriuretic peptide (NT-proBNP) in determining CAD severity.

Methods: This cross-sectional study included 125 participants categorized by coronary angiographic results into 3 groups: group I (no or < 50% stenosis), group II (1 or 2 vessels with ≥ 50% stenosis), and group III (left main stem or ≥ 3 vessels with ≥ 50% obstruction). Serum hs-cTnI and NT-proBNP levels were measured by enzyme-linked immunosorbent assay. Data were analyzed using SPSS version 25.0 and described as percentages, means, medians, and interquartile ranges (Q1–Q3). Receiver operating characteristic curves and relative quality were applied for both biomarkers.

Results: Median hs-cTnI and NT-proBNP levels were higher in group III than in groups I and II (P = .001). Both were higher in group II than in group I (P = .001). Receiver operating characteristic analysis showed that hs-cTnI and NT-proBNP effectively discriminated vascular obstruction severity with high sensitivity and specificity. Relative quality testing results showed a slight increase in predictive ability when the 2 biomarkers were combined.

Conclusions: Serum hs-cTnI and NT-proBNP levels, combined or separately, can be used to assess CAD severity concerning the number of diseased vessels, which may help improve risk stratification and management strategy selection. (Iranian Heart Journal 2026; 27(3): 20-26)
Keywords
cardiac biomarkers
noninvasive diagnosis
risk stratification
coronary stenosis
1.         World Health Organization. World health sWORLD HEALTH ORGANIZATION - World health statistics 2024. ISBN 9789240094703. tatistics 2024. 2024. 1–96 p.
2.         Björkegren JLM, Lusis AJ. Atherosclerosis : Recent Developments. 2023;185(10):1630–45.
3.         Luo X, Lv Y, Bai X, Qi J, Weng X, Liu S, et al. Plaque Erosion: A Distinctive Pathological Mechanism of Acute Coronary Syndrome. Front Cardiovasc Med. 2021; 8(September):1–11.
4.         Majeed SM, Bahjet Al Saffar H, AL- Marayati AN. Complication Following percutaneous coronary intervention via the femoral artery Experience in lraqi center for the Heart Disease and lbn Al-Bitar Hospital for cardiac surgery. J Fac Med Baghdad. 2016; 58(4):325–9.
5.         Wallentin L, Eriksson N, Olszowka M, Grammer TB, Hagström E, Held C, et al. Plasma proteins associated with cardiovascular death in patients with chronic coronary heart disease: A retrospective study. PLoS Med. 2021; 18(1):1–22.
6.         Sweeney HL, Hammers DW. Muscle contraction. Cold Spring Harb Perspect Biol. 2018; 10(2).
7.         Wu AHB. Release of cardiac troponin from healthy and damaged myocardium. Front Lab Med [Internet]. 2017; 1(3):144–50. Available from: https://doi.org/10.1016/j.flm.2017.09.003
8.         Tveit SH, Myhre PL, Hanssen TA, Forsdahl SH, Iqbal A, Omland T, et al. Cardiac troponin I and T for ruling out coronary artery disease in suspected chronic coronary syndrome. Sci Rep. 2022 Dec 1; 12(1).
9.         Nishikimi T, Nakagawa Y. B-Type Natriuretic Peptide (BNP) Revisited—Is BNP Still a Biomarker for Heart Failure in the Angiotensin Receptor/Neprilysin Inhibitor Era? Biology (Basel). 2022; 11(7).
10.      Nasser TH, El-Yassin HD, Yakoob S. Β-Natriuretic Peptide Level as a Predictor for the Severity of LV Dysfunction. J Fac Med Baghdad. 2008; 49(4):438–48.
11.      Kragelund C, Gustafsson I, Omland T, Grønning B, Køber L, Faber J, et al. Prognostic value of NH2-terminal pro B-type natriuretic peptide in patients with diabetes and stable coronary heart disease. Diabetes Care. 2006; 29(6):1411–3.
12.      Kawabe M, Sato A, Hoshi T, Endo M, Yoshida I, Aonuma K. Incremental value of B-type natriuretic peptide for detection and risk reclassification of obstructive coronary artery disease on computed tomography angiography. J Cardiol [Internet]. 2017; 69(4):671–7. Available from: http://dx.doi.org/10.1016/j.jjcc.2016.06.008
13.      Ahmed SK. How to choose a sampling technique and determine sample size for research: A simplified guide for researchers. Oral Oncol Reports [Internet]. 2024 Dec;12:100662. Available from: https://linkinghub.elsevier.com/retrieve/pii/S2772906024005089
14.      Edition T, Thompson SK, Wiley J, Wiley J. Estimating Proportions, Ratios, and Subpopulation Means. 2012; 57–66.
15.      Almahmeed W, Samir Arnaout M, Chettaoui R, Ibrahim M, Ibrahim Kurdi M, Awad Taher M, et al. Coronary artery disease in Africa and the Middle East. Ther Clin Risk Manag. 2012; 8:65–72.
16.      Lima Dos Santos CC, Matharoo AS, Pinzón Cueva E, Amin U, Perez Ramos AA, Mann NK, et al. The Influence of Sex, Age, and Race on Coronary Artery Disease: A Narrative Review. Cureus. 2023; 15(10).
17.      Omidi N, Sadeghian S, Salarifar M, Jalali A, Abbasi SH, Yavari N, et al. Relationship between the severity of coronary artery disease and cardiovascular risk factors in acute coronary syndrome: Based on tehran heart center’s data registry. J Tehran Univ Hear Cent. 2020; 15(4):171–6.
18.      Charach L, Blatt A, Jonas M, Teodorovitz N, Haberman D, Gendelman G, et al. Using the Gensini score to estimate severity of STEMI, NSTEMI, unstable angina, and anginal syndrome. Med (United States). 2021; 100(41):E27331.
19.      Aksu F, Ahmed S. Gensini Score’s Severity and Its Relationship with Risk Factors for Coronary Artery Disease Among Patients Who Underwent Angiography in Somalia’s Largest PCI Centre. Int J Gen Med. 2024; Volume 17(January):187–92.
20.      Salehi N, Janjani P, Tadbiri H, Rozbahani M, Jalilian M. Effect of cigarette smoking on coronary arteries and pattern and severity of coronary artery disease: a review. J Int Med Res. 2021; 49(12).
21.      Rgeeb AN, Alsalkh HA, Radhi AK, Amber K. Effect of Intravenous Abciximab on Coronary Flow Improvement After Re-vascularization in Primary Coronary Intervention and Short Term Impact. Med Arch (Sarajevo, Bosnia Herzegovina). 2020; 74(4):265–9.
22.                      Kodaira M, Miyata H, Numasawa Y, Ueda I, Maekawa Y, Sueyoshi K, et al. Effect of smoking status on clinical outcome and efficacy of clopidogrel in acute coronary syndrome. Circ J. 2016; 80(7):1590–9.
23.      Pirie K, Peto R, Reeves GK, Green J, Beral V. The 21st century hazards of smoking and benefits of stopping: A prospective study of one million women in the UK. Lancet [Internet]. 2013;381(9861):133–41. Available from: http://dx.doi.org/10.1016/S0140-6736(12)61720-6
24.      Myhre PL, Røsjø H, Sarvari SI, Ukkonen H, Rademakers F, Engvall JE, et al. Cardiac troponin T and NT-proBNP for detecting myocardial ischemia in suspected chronic coronary syndrome. Int J Cardiol. 2022; 361(April):14–7.
25.      Askin L. Clinical Importance of High-Sensitivity Troponin T in Patients without Coronary Artery Disease. North Clin Istanbul. 2019;
26.      Park KC, Gaze DC, Collinson PO, Marber MS. Cardiac troponins: From myocardial infarction to chronic disease. Cardiovasc Res. 2017; 113(14):1708–18.
27.      Fang Z, Zhou L, Bao Y, Ding W, Shi H, Luo X, et al. Association of NT-proBNP and multiple biomarkers with severity of angiographic coronary artery disease in diabetic and pre-diabetic chinese patients. PLoS One. 2011; 6(8).
28.      Jehn S, Mahabadi AA, Pfohl C, Vogel L, Al-Rashid F, Luedike P, et al. BNP and NT-proBNP Thresholds for the Assessment of Prognosis in Patients Without Heart Failure. JACC Adv [Internet]. 2023;2(10):100688. Available from: https://doi.org/10.1016/j.jacadv.2023.100688
29.      Zayed MA, Harring S, Abendschein D, Vemuri C, Lu D, Detering L, et al. Natriuretic Peptide Receptor-C is Up-Regulated in the Intima of Advanced Carotid Artery Atherosclerosis. J Med Surg Pathol. 2016; 131(3):139–48.
30.    Souaid T, Hijazi Z, Barakett V, Sarkis A, Kadri Z, Batra G, et al. Association of GDF-15, hs-cTnT and NT-proBNP with coronary artery disease in patients undergoing elective angiography. Future Cardiol. 2022; 18(8):635–46.
Iranian Heart Journal
Volume 27, Issue 3
Summer 2026
Pages 20-26