Author + information
- Dirk Lok,
- IJsbrand Klip,
- Sjoukje I. Lok,
- Pieta W. Bruggink Andre de la Porte,
- Erik Badings,
- Jan van Wijngaarden,
- Adriaan Voors,
- Rudolf de Boer,
- Dirk van Veldhuisen and
- Peter van der Meer
Elevated natriuretic peptides provide strong prognostic information in patients with heart failure (HF). The role of novel biomarkers in HF needs to be established. Our objective was to evaluate the prognostic power of novel biomarkers, incremental to the N- terminal part of the natriuretic peptide (NT-proBNP) in chronic HF.
Levels of circulating NT-proBNP, Growth Differentiation Factor 15 (GDF-15), high sensitive C-Reactive Protein (hs-CRP), Galectin-3 (Gal-3) and high sensitive Troponin ? (hs-TnT) were measured and related to all-cause long-term mortality. Of 209 patients (age 71 ± 10 years, 73% males, 97% NYHA class Ill), 151 (72 %) died during a median follow-up of 8.7 ± 1 year.
The calculated area under the curve for NT-proBNP was 0.63, GDF-15 0.78, hs-CRP 0.66, Gal-3 0.68, and hs-TnT 0.68 (all; p <0.01). Each marker was predictive for mortality in univariate analysis. In multivariate analysis, elevated levels of GDF-15 (HR 1.41, Cl 1.1-178, p=0.005), hs-CRP (HR 1.38, Cl 1.15-1.67, p=0.001) and hs-TnT (HR 1.27, Cl 1.06-1.53, p=0.008) were independently related to mortality. All novel markers had an incremental value to NT-proBNP, using the integrated discrimination improvement.
In chronic HF, GDF-15, hs-CRP and hs-TnT are independent prognostic markers, incremental to NT-proBNP, in predicting long-term mortality. In this study, GDF-15 is the most predictive marker, even stronger than NT-proBNP.
|Variable||GDF-15 (per SD)||Z||p-value||hs-CRP (per SD)||Z||p-value||Galectin-3 (per SD)||Z||p-value||hs-TnT (per SD)||Z||p-value|
|HR (95% Cl)||HR (95% Cl)||HR (95% Cl)||HR (95% Cl)|
|Univariate||1.69 (1.43–1.98)||6.31||< 0.001||1.55 (1.31–1.83)||5.15||< 0.001||1.41 (1.20–1.64)||4.30||< 0.001||1.53 (1.32–1.78)||5.65||< 0.001|
|Model 1||1.56 (1.31–1.86)||4.94||< 0.001||1.47 (1.26–1.73)||4.70||< 0.001||1.30 (1.10–1.53)||3.11||0.002||1.45 (1.24–1.71)||4.54||< 0.001|
|Model 2||1.45 (1.18–1.79)||3.45||0.001||1.42 (1.19–1.70)||3.93||< 0.001||1.27 (1.04–1.57)||2.35||0.019||1.36 (1.14–1.62)||3.39||0.001|
|Model 3||1.41 (1.11–1.78)||2.81||0.005||1.38 (1.15–1.67)||3.41||0.001||1.06 (0.84–1.32)||0.47||0.638||1.27 (1.06–1.53)||2.63||0.008|
GDF-15, Growth differentiation factor 15; hs-CRP, high-sensitive C-reactive protein; HR, Hazard ratio; 95% Cl, 95% Confidence interval; HF, Heart failure; eGFR, estimated glomerular filtration rate; NT-proBNP, N-terminal pro brain natriuretic peptide.
Model 1: adjusted for age and gender
Model 2: adjusted for model 1 + renal function (eGFR), HF etiology and NT-proBNP
Model 3: adjusted for model 2 + novel biomarkers (combination of GDF-15, hs-TnT, Gal-3 and/or hs-CRP)
Poster Sessions, Expo North
Sunday, March 10, 2013, 3:45 p.m.-4:30 p.m.
Session Title: New Paradigms in Prognostic Role of Biomarkers in Heart Failure
Abstract Category: 15. Heart Failure: Clinical
Presentation Number: 1265-309
- 2013 American College of Cardiology Foundation