Abstract 2705: Prognostic Value of Multi-biomarker Approach Using Cystatin C, BNP and Cardiac Troponin T after Initiation of Treatment in Patients with Chronic Heart Failure
Cystatin C, BNP, and cardiac troponin T (TnT) each predict adverse cardiac events in patients with chronic heart failure (CHF). Little is known, however, about the utility of these biomarkers in combination. Thus, we prospectively evaluated whether the simultaneous assessment of these biomarkers would effectively stratify patients with CHF after initiation of treatment.
Methods: Cystatin C, BNP and TnT were measured on admission for worsening CHF (NYHA functional class III to IV) and 2 months after initiation of treatment to stabilize CHF (n = 284;and mean age of 70 yrs).
Results: Concentrations of BNP (mean: 319 vs 979 pg/ml) and TnT (0.06 vs 0.13 ng/ml), percentage of detected TnT (>0.01 ng/ml: 42% vs 62%), NYHA functional class (2.3 vs 3.5), and left ventricular ejection fraction (42% vs 38%) were significantly (P<0.0001) improved 2 months after treatment, but cystatin C concentrations (1.71 vs 1.43 mg/l) were significantly (P<0.0001) elevated at 2 months compared with admission. During a mean follow-up period of 706 days, there were 128 (45%) cardiac events including 33 cardiac deaths and 95 readmissions for worsening CHF. On a stepwise Cox regression analysis including 10 clinical and biochemical variables after treatment, elevation in cystatin C (above the median of 1.41 mg/l: relative risk [RR] = 1.6; P = 0.02), BNP (above the median of 226 pg/ml: RR = 2.3; P<0.0001) and TnT (above the median of 0.01 ng/ml: RR = 1.6; P = 0.03) were independently associated with cardiac events. The number of elevated biomarkers 2 months after initiation of treatment was correlated with an incremental increase in cardiac mortality and morbidity rates (Table⇓).
Conclusions: Cystatin C, BNP, and TnT each provide unique prognostic information in patients with CHF after initiation of treatment. A simple multi-biomarker strategy that categorizes patients based on the number of elevated biomarkers after initiation of treatment may be highly effective for risk stratification of this population.