Prognostic markers of acute decompensated heart failure: The emerging roles of cardiac biomarkers and prognostic scores

Cohen‐Solal, Alain; Laribi, Sai͏̈d; Ishihara, Shiro; Vergaro, Giuseppe; Baudet, Mathilde; Logeart, Damien; Mebazaa, Alexandre; Gayat, Étienne; Vodovar, Nicolas; Pascual-Figal, Domingo A.; Seronde, Marie‐France

doi:10.1016/j.acvd.2014.10.002

Cited by 33 publications

(32 citation statements)

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“…However, the majority of included studies examined chronic HF, with only 4 out of 23 papers relating to AHF, although patients with AHF constituted approximately half of the cohort. Furthermore, the burden of HF has shifted over the recent years from CHF to AHF, for which effective and time-sensitive outcome predictors are urgently needed 14. This AHF-specific analysis on the utility of CA125 will complement well with Zhuang et al 15 to provide a holistic picture of CA125 as a prognostic marker for CHF as well as AHF.…”

Section: Discussionmentioning

confidence: 88%

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Cancer antigen-125 and outcomes in acute heart failure: a systematic review and meta-analysis

Li¹,

Gong

et al. 2018

Heart Asia

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BackgroundCarbohydrate antigen-125 (CA125) is an ovarian cancer marker, but recent work has examined its role in risk stratification in heart failure. A recent meta-analysis examined its prognostic value in heart failure generally. However, there has been no systematic evaluation of its role specifically in acute heart failure (AHF).MethodsPubMed and EMBASE databases were searched until 11 May 2018 for studies that evaluated the prognostic value of CA125 in AHF.ResultsA total of 129 and 179 entries were retrieved from PubMed and EMBASE. Sixteen studies (15 cohort studies, 1 randomised trial) including 8401 subjects with AHF (mean age 71 years old, 52% male, mean follow-up 13 months, range of patients 525.1±598.2) were included. High CA125 levels were associated with a 68% increase in all-cause mortality (8 studies, HRs: 1.68, 95% CI 1.36 to 2.07; p<0.0001; I2: 74%) and 77% increase in heart failure-related readmissions (5 studies, HRs: 1.77, 95% CI 1.22 to 2.59; p<0.01; I2: 73%). CA125 levels were higher in patients with fluid overload symptoms and signs compared with those without them, with a mean difference of 54.8 U/mL (5 studies, SE: 13.2 U/mL; p<0.0001; I2: 78%).ConclusionOur meta-analysis found that high CA125 levels are associated with AHF symptoms, heart failure-related hospital readmissions and all-cause mortality. Therefore, CA125 emerges as a useful risk stratification tool for identifying high-risk patients with more severe fluid overload, as well as for monitoring following an AHF episode.

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Section: Discussionmentioning

confidence: 88%

“…Despite the effectiveness of some of the prognostic markers, the difficulty remains in obtaining determinable predictors in a short time frame for patients with AHF 14. Furthermore, a meta-analysis has been published on the prognostic value of CA125 in HF,15 but only 4 of the 23 included studies concerned patients with AHF.…”

Section: Introductionmentioning

confidence: 99%

Cancer antigen-125 and outcomes in acute heart failure: a systematic review and meta-analysis

Li¹,

Gong

et al. 2018

Heart Asia

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“…I n many different areas of cardiovascular physiology [1], cardiac biomarkers have been shown to be very useful tools in evaluating cardiac (dys)function [2], assessing diagnosis [3,4], guiding subsequent management [5], stratifying prognosis [6], as well as assessing total cardiovascular risk [7]. Moreover, they significantly contribute to our knowledge of mechanisms of disease genesis and progression.…”

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confidence: 99%

NT-proBNP and the risk of incident hypertension

Perlini

Salinaro

Perrone

2015

Journal of Hypertension

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See original paper on page 966 I n many different areas of cardiovascular physiology [1], cardiac biomarkers have been shown to be very useful tools in evaluating cardiac (dys)function [2], assessing diagnosis [3,4], guiding subsequent management [5], stratifying prognosis [6], as well as assessing total cardiovascular risk [7]. Moreover, they significantly contribute to our knowledge of mechanisms of disease genesis and progression. In this area, the release of natriuretic peptides has been extensively studied in the past decades, and B-type natriuretic peptide (BNP) has been defined as a 'window' to the cardiovascular system [8], able to help clinicians in diagnosis, follow-up, and prognostication [9][10][11]. This is the case not only for heart failure [12,13] but also for specific cardiac diseases, such as amyloid cardiomyopathy [14][15][16][17], congenital heart disease [18], hypertrophic cardiomyopathy [19], pulmonary embolism [20], and many other conditions [21].In the setting of arterial hypertension, the role of natriuretic peptides is complex. On the one hand, a higher serum concentration of BNP is a rather robust marker of pressureinduced cardiac damage [22], on the one hand a reduced risk of hypertension has been associated with genetically elevated concentrations of either BNP or the N-terminal fragment of proBNP (NT-proBNP) [23,24]. Among many others, the main effects of BNP are vasodilation as well as natriuresis, both representing key mechanisms in arterial pressure control and in the cardio-renal cross-talk. Opposite effects are exerted by the renin-angiotensin-aldosterone system, and it has been recently shown that natriuretic peptides buffer renal vascular hypertension via reninindependent effects [25]. BNP is released by ventricular cardiomyocytes as a result of 'spontaneous' and 'inducible' production, the former being largely under genetic control and the latter being stimulated by mechanical stretch, as well as by direct or indirect toxic effects. The final serum concentration results from the net balance between production, degradation, and renal clearance. The many modifications of cardiac, arterial, as well as kidney function that are associated with hypertension may therefore affect BNP serum concentration, being concomitantly possible targets of BNP-mediated effects. A possible role of diminished vasodilation and natriuresis in the pathogenesis of hypertension has been very recently suggested by Seven et al. [26], showing that lower 'baseline' NT-proBNP concentrations were associated with a higher risk of developing hypertension during the 5-year follow-up of a cohort of 5307 participants. However, they did not report 'changes' of serum levels of natriuretic peptides over time in patients who did develop hypertension as compared with patients whose blood pressure remained in the normotensive range. The hypothesis that NT-proBNP changes (DNT-proBNP) are associated with the subsequent incidence of hypertension was evaluated in a study published in the current issue of the Journal of Hype...

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“…Age, brain natriuretic peptide, and N-terminal pro-brain natriuretic peptide (NT-proBNP) levels have been shown to correlate with postdischarge rates of readmission and mortality. 5 A study evaluating the prognostic value of a bedside inferior vena cava (IVC) ultrasound exam demonstrated that lack of improvement in IVC distention from admission to discharge was associated with higher 30-day readmission rates. 6 Two studies using data from comprehensive transthoracic echocardiograms in heart failure patients demonstrated that a dilated, noncollapsible IVC is associated with higher risk of mortality; however, it is well recognized that obtaining comprehensive transthoracic echocardiograms in all patients hospitalized with heart failure is neither cost-effective nor practical.…”

Section: Resultsmentioning

confidence: 99%

Admission inferior vena cava measurements are associated with mortality after hospitalization for acute decompensated heart failure

Cubo-Romano

Torres‐Macho

Soni

et al. 2016

Journal of Hospital Medicine

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BACKGROUND Prognostication of patients hospitalized with acute decompensated heart failure (ADHF) is important to patients, providers, and healthcare systems. Few bedside tools exist to prognosticate patients hospitalized with ADHF. OBJECTIVE The objective of this study was to assess the relationship between inferior vena cava (IVC) diameter and postdischarge mortality in patients hospitalized with ADHF. DESIGN Prospective observational study. SETTING A 247‐bed urban teaching hospital in Spain PATIENTS Ninety‐seven patients hospitalized with ADHF. INTERVENTION None. MEASUREMENTS The IVC diameter and collapsibility were measured by a hospitalist at the time of admission and discharge. Primary outcome was 90‐day all‐cause mortality. Secondary outcomes were readmission rates at 90 and 180 days, and 180‐day all‐cause mortality. Patients were followed for 180 days. RESULTS Data from 80 patients were analyzed. From admission to discharge, a significant improvement in IVC maximum (IVCmax) diameter (2.12 vs 1.87 cm; P < 0.001) and IVC collapsibility (25.7% vs 33.1%; P < 0.001) was seen in the total study cohort. During the 90‐day follow‐up period, 11 patients (13.7%) died. An admission IVCmax diameter ≥1.9 cm was associated with a higher mortality rate at 90 days (25.4% vs 3.4%; P = 0.009) and 180 days (29.3% vs 3.4%; P = .003). In a multivariate Cox proportional hazards regression analysis, admission IVCmax diameter was an independent predictor of 90‐day mortality (hazard ratio [HR]: 5.88; 95% confidence interval [CI]: 1.21‐28.10; P = 0.025) and 90‐day readmission (HR: 3.20; 95% CI: 1.24‐8.21; P = 0.016). CONCLUSION In patients hospitalized with acute decompensated heart failure, a dilated IVC by bedside ultrasound at the time of admission is associated with a higher 90‐day mortality after hospitalization. Journal of Hospital Medicine 2016;11:778–784. © 2016 Society of Hospital Medicine

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Prognostic markers of acute decompensated heart failure: The emerging roles of cardiac biomarkers and prognostic scores

Cited by 33 publications

References 68 publications

Cancer antigen-125 and outcomes in acute heart failure: a systematic review and meta-analysis

Cancer antigen-125 and outcomes in acute heart failure: a systematic review and meta-analysis

NT-proBNP and the risk of incident hypertension

Admission inferior vena cava measurements are associated with mortality after hospitalization for acute decompensated heart failure

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