Predischarge B-type natriuretic peptide assay for identifying patients at high risk of re-admission after decompensated heart failure

Logeart, Damien; Thabut, Gabriel; Jourdain, Patrick; Chavelas, Christophe; Beyne, Pascale; Beauvais, Florence; Bouvier, Erik; Solal, Alain Cohen

doi:10.1016/j.jacc.2003.09.044

Cited by 527 publications

(160 citation statements)

References 36 publications

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“…Although some indicators, including sodium and BNP levels, are considered to be useful to predict cardiac events, it has been reported that few indicators evaluated at the decompensated stage are independent prognostic markers. For example, a high BNP level at discharge is generally considered to be a strong independent marker of death or re‐admission for heart failure 37, 38. However, the prognostic impact of BNP level on admission on ADHF appears to be weak and is less than that of BNP level at discharge after appropriate treatment for ADHF.…”

Section: Discussionmentioning

confidence: 99%

Subclinical hypothyroidism is an independent predictor of adverse cardiovascular outcomes in patients with acute decompensated heart failure

et al. 2016

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AimsAltered thyroid hormone metabolism characterized by a low triiodothyronine (T3), so‐called low‐T3 syndrome, is a common finding in patients with severe systemic diseases. Additionally, subclinical thyroid dysfunction, defined as abnormal thyroid stimulating hormone (TSH) and normal thyroxine (T4), causes left ventricular dysfunction. Our objective was to identify the prevalence and prognostic impact of low‐T3 syndrome and subclinical thyroid dysfunction in patients with acute decompensated heart failure (ADHF).Methods and resultsWe examined 274 ADHF patients who were not receiving thyroid medication or amiodarone on admission (70 ± 15 years, 156 male), who underwent thyroid function tests. Euthyroidism was defined as TSH of 0.45 to 4.49 mIU/L; subclinical hypothyroidism as TSH of 4.5 to 19.9 mIU/L; and subclinical hyperthyroidism as TSH < 0.45 mIU/L, with normal free T4 level for the last two. Additionally, low‐T3 syndrome was defined as free T3 < 4.0 pmol/L among euthyroidism subjects. On admission, 188 patients (69%) showed euthyroidism, 58 (21%) subclinical hypothyroidism, 5 (2%) subclinical hyperthyroidism, and 95 (35%) low‐T3 syndrome. Cox proportional hazards models revealed that higher TSH, but not free T3 and free T4, was independently associated with composite cardiovascular events, including cardiac death and re‐hospitalization for heart failure. Indeed, subclinical hypothyroidism was an independent predictor (hazard ratio: 2.31; 95% confidence interval: 1.44 to 3.67; P < 0.001), whereas low‐T3 syndrome and subclinical hyperthyroidism were not.ConclusionsSubclinical hypothyroidism on admission was an independent predictor of adverse cardiovascular outcomes in ADHF patients, suggesting a possible interaction between thyroid dysfunction and the pathophysiology of ADHF.

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Section: Discussionmentioning

confidence: 99%

Subclinical hypothyroidism is an independent predictor of adverse cardiovascular outcomes in patients with acute decompensated heart failure

et al. 2016

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“…NT‐proBNP (Elecsys 2010 analyzer, Roche Diagnostics, Indianapolis, IN) and copeptin and MR‐proANP (both on the KRYPTOR system) were measured centrally with the support of BRAHMS/Thermo Fisher, Germany. MR‐proADM was measured using an automated sandwich chemiluminescence immunoassay on the KRYPTOR system, as previously described 18, 19. For MR‐proADM, the limit of quantification was 0.23 nmol/L; the within‐run imprecision (coefficient of variation) was 1.9%, and the between‐run imprecision (coefficient of variation) was 9.8%.…”

Section: Methodsmentioning

confidence: 99%

Prognostic performance of serial in‐hospital measurements of copeptin and multiple novel biomarkers among patients with worsening heart failure: results from the MOLITOR study

et al. 2018

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AimsIn heart failure, various biomarkers are established for diagnosis and risk stratification; however, little is known about the relevance of serial measurements during an episode worsening heart failure (WHF). This study sought to investigate the trajectory of natriuretic peptides and multiple novel biomarkers during hospitalization for WHF and to determine the best time point to predict outcome.Methods and resultsMOLITOR (Impact of Therapy Optimisation on the Level of Biomarkers in Patients with Acute and Decompensated Chronic Heart Failure) was an eight‐centre prospective study of 164 patients hospitalized with a primary diagnosis of WHF. C‐terminal fragment of pre‐pro‐vasopressin (copeptin), N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP), mid‐regional pro‐atrial natriuretic peptide (MR‐proANP), mid‐regional pro‐adrenomedullin (MR‐proADM), and C‐terminal pro‐endothelin‐1 (CT‐proET1) were measured on admission, after 24, 48, and 72 h, and every 72 h thereafter, at discharge and follow‐up visits. Their performance to predict all‐cause mortality and rehospitalization at 90 days was compared. All biomarkers decreased during recompensation (P < 0.05) except MR‐proADM. Copeptin at admission was the best predictor of 90 day mortality or rehospitalization (χ 2 = 16.63, C‐index = 0.724, P < 0.001), followed by NT‐proBNP (χ 2 = 10.53, C‐index = 0.646, P = 0.001), MR‐proADM (χ 2 = 9.29, C‐index = 0.686, P = 0.002), MR‐proANP (χ 2 = 8.75, C‐index = 0.631, P = 0.003), and CT‐proET1 (χ 2 = 6.60, C‐index = 0.64, P = 0.010). Re‐measurement of copeptin at 72 h and of NT‐proBNP at 48 h increased prognostic value (χ 2 = 23.48, C‐index = 0.718, P = 0.00001; χ 2 = 14.23, C‐index = 0.650, P = 0.00081, respectively).ConclusionsThis largest sample of serial measurements of multiple biomarkers in WHF found copeptin at admission with re‐measurement at 72 h to be the best predictor of 90 day mortality and rehospitalization.

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“…The role of BNP and uric acid has been well established in numerous studies in patients with HF. High BNP levels are associated with higher NYHA class and worse outcomes [6]. BNP is measured as a screening test to identify asymptomatic patients with left ventricular dysfunction and early HF [7].…”

Section: (37)mentioning

confidence: 99%

Wartość oznaczania stężeń antygenu nowotworowego Ca 125 i kopeptyny w monitorowaniu terapii chorych z zaawansowaną niewydolnością serca

et al. 2017

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Predischarge B-type natriuretic peptide assay for identifying patients at high risk of re-admission after decompensated heart failure

Abstract: High predischarge BNP assay is a strong, independent marker of death or re-admission after decompensated CHF, more relevant than common clinical or echocardiographic parameters and more relevant than changes in BNP levels during acute cares.

Cited by 527 publications

References 36 publications

Subclinical hypothyroidism is an independent predictor of adverse cardiovascular outcomes in patients with acute decompensated heart failure

Subclinical hypothyroidism is an independent predictor of adverse cardiovascular outcomes in patients with acute decompensated heart failure

Prognostic performance of serial in‐hospital measurements of copeptin and multiple novel biomarkers among patients with worsening heart failure: results from the MOLITOR study

Wartość oznaczania stężeń antygenu nowotworowego Ca 125 i kopeptyny w monitorowaniu terapii chorych z zaawansowaną niewydolnością serca

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