Usefulness of clinical and NT-proBNP monitoring for prognostic guidance in destabilized heart failure outpatients

Pascual-Figal, Domingo A.; Domingo, Manel Puig; Casas, Teresa; Gich, Ignasi; Ordóñez-Llanos, Jordi; Martínez, P. Alonso; Cinca, Juan; Valdés, Mariano; Januzzi, James L.; Bayés‐Genís, Antoni

doi:10.1093/eurheartj/ehn023

Cited by 70 publications

(35 citation statements)

References 23 publications

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“…Emerging evidence suggests that ascertainment of changes in natriuretic peptide concentrations over time may be useful in risk assessment, as well as for monitoring and directing therapy in patients with HF [21,22,23,24,25], and it has stimulated interest in whether a similar approach may be valuable using serial samples of other biomarkers such as sST2. As has been shown with norepinephrine, endothelin-1 and natriuretic peptides [26], our data indicate that sST2 levels can be reduced with intervention designed to improve clinical status in patients with ADHF.…”

Section: Discussionmentioning

confidence: 99%

Serial Monitoring of Soluble Interleukin Family Member ST2 in Patients with Acutely Decompensated Heart Failure

et al. 2012

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Objectives: To determine whether serial measures of the interleukin receptor family member soluble ST2 (sST2) provide additional prognostic information to baseline measures for long-term risk stratification of acutely decompensated heart failure (ADHF) patients. Methods: We prospectively enrolled 72 ADHF patients. Blood samples were collected to measure sST2 concentrations at presentation and on day 4 of hospitalization. All patients were clinically followed, and vital status was registered. Results: Between presentation and day 4, sST2 concentrations decreased from 62 ng/ml (interquartile range 38–105) to 44 ng/ml (interquartile range 26–72; p < 0.001). Both sST2 concentrations at presentation [hazard ratio (HR) 1.011, 95% confidence interval (CI) 1.005–1.016; p < 0.001] and on day 4 (HR 1.015, 95% CI 1.005–1.024; p = 0.003) were independent predictors of mortality. Patients with sST2 ≤76 ng/ml at presentation and ≤46 ng/ml on day 4 had the lowest mortality rates (3%), whereas those with both sST2 values above these cutoff points had the highest mortality (50%). C index and reclassification analyses demonstrated that the use of serial sST2 measures resulted in an improvement in the accuracy of mortality prediction. Conclusions: Among ADHF patients, sST2 concentrations tend to decrease following initiation of treatment and are prognostic both at presentation and during hospitalization. Serial sampling of sST2 adds prognostic information and may provide a basis for enhanced clinical decision making.

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Section: Discussionmentioning

confidence: 99%

Serial Monitoring of Soluble Interleukin Family Member ST2 in Patients with Acutely Decompensated Heart Failure

et al. 2012

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“…Numerous studies have examined the value of natriuretic peptides to assess the prognosis of HF [33][34][35][36] , most of them performed in the emergency room or in patients with acute decompensated HF requiring hospitalization. Few of the studies focus on stable chronic HF [37,38] .…”

Section: Previous Studiesmentioning

confidence: 99%

Prognostic value of increased carbohydrate antigen in patients with heart failure

Méndez

Ordóñez-Llanos

Ferrero

et al. 2014

WJC

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Author contributions: Mendez AB contributed to design of the study, analysis and interpretation of data, manuscript writing and final approval of manuscript; Ordoñez-Llanos J contributed to analysis of data, review of CA125 and NT-proBNP determinations and substantial contribution to manuscript review; Ferrero A contributed to statistical assessment and substantial contribution to manuscript review; Noguero M contributed to patient selection and follow-up, Serotec and analysis of data; Mir T and Mora J contributed to CA125 and NT-proBNP determinations, analysis of data, substantial contribution to manuscript; Bayes-Genis A and Mirabet S contributed to patient selection and follow-up, analysis of data, substantial contribution to manuscript; Cinca J contributed to design of the study and substantial contribution to manuscript review; Roig E contributed to design of the study, selection of patients, analysis of data, and substantial contribution to manuscript review. Abstract AIM: To study the prognostic value of carbohydrate antigen 125 (CA125) and whether it adds prognostic information to N-terminal pro-brain natriuretic peptide (NT-proBNP) in stable heart failure (HF) patients. METHODS:The predictive value of CA125 was retrospectively assessed in 156 patients with stable HF remitted to the outpatient HF unit for monitoring from 2009 to 2011. Patients were included in the study if they had a previous documented episode of HF and received HF treatment. CA125 and NT-proBNP concentrations were measured. The independent association between NT-proBNP or CA125 and mortality was assessed with Cox regression analysis, and their combined predictive ability was tested by the integrated discrimination improvement (IDI) index. RESULTS:The mean age of the 156 patients was 72 ± 12 years. During follow-up (17 ± 8 mo), 27 patients died, 1 received an urgent heart transplantation and 106 required hospitalization for HF. Higher CA125 values were correlated with outcomes: 58 ± 85 KU/L if hospitalized vs 34 ± 61 KU/L if not (P < 0.05), and 94 ± 121 KU/L in those who died or needed urgent heart transplantation vs 45 ± 78 KU/L in survivors (P < 0.01).After adjusting for propensity scores, the highest risk was observed when both biomarkers were elevated vs not elevated (HR = 8.95, 95%CI: 3.11-25.73; P < 0.001) and intermediate when only NT-proBNP was elevated vs not elevated (HR = 4.15, 95%CI: 1.41-12.24; P < 0.01). Moreover, when CA125 was added to the clinical model with NT-proBNP, a 4% (P < 0.05) improvement in the IDI was found.CONCLUSION: CA125 > 60 KU/L identified patients in stable HF with poor survival. Circulating CA125 level adds prognostic value to NT-proBNP level in predicting HF outcomes.© 2014 Baishideng Publishing Group Co., Limited. All rights reserved. Key words: Heart failure; Prognosis; Carbohydrate antigen 125; Brain natriuretic peptides; Survival Core tip: Increased carbohydrate antigen 125 (CA125) has prognostic implications in acute heart failure (HF). The aim of this study was to assess the prognostic value of ...

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“…Thus better prognostics, improved targeting of current therapies, and novel therapies are still needed. The relevance of the natriuretic peptide (NP) system, particularly B-type NP (BNP), is well known in terms of HF pathophysiology [2,3], diagnosis [4], prognosis [5], and therapy [6,7]. Moreover, the response to extrinsic NP (e.g.…”

Section: Introductionmentioning

confidence: 99%

Genetic and Non-Genetic Factors Influencing Pharmacokinetics of B-type Natriuretic Peptide

Lanfear

Cabrera-Salinas

Chow

et al. 2014

Journal of Cardiac Failure

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Usefulness of clinical and NT-proBNP monitoring for prognostic guidance in destabilized heart failure outpatients

Abstract: Serial monitoring for per cent change in NT-proBNP concentrations offers superior prognostic information to clinical assessment among outpatients with recent destabilized HF.

Cited by 70 publications

References 23 publications

Serial Monitoring of Soluble Interleukin Family Member ST2 in Patients with Acutely Decompensated Heart Failure

Serial Monitoring of Soluble Interleukin Family Member ST2 in Patients with Acutely Decompensated Heart Failure

Prognostic value of increased carbohydrate antigen in patients with heart failure

Genetic and Non-Genetic Factors Influencing Pharmacokinetics of B-type Natriuretic Peptide

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