Abstract 806: Prognostic Value of Multimarker Approach Using Cardiac Troponin T, N-Terminal Pro-B-Type Natriuretic Peptide, and Cystatin C in Patients Hospitalized for Worsening Chronic Heart Failure
Background: In patients with chronic heart failure (CHF), cardiac troponin T (TnT), N-terminal pro-B-type natriuretic peptide (NT-proBNP), and cystatin C each predict adverse events. Little is known, however, about the prognostic value of these biomarkers in combination.
Methods: Admission measurements of TnT, NT-proBNP, and cystatin C were performed in 367 consecutive patients hospitalized for worsening CHF (median age, 74 years), of which 136 patients belonged to NYHA functional class III and 231 to class IV. The median left ventricular ejection fraction (LVEF) was 35%.
Results: During 12 months after admission, there were 59 (16%) cardiac deaths. Patients who died from cardiac causes had higher levels of TnT (median 0.057 vs. 0.020 ng/ml; P < 0.0001), NT-proBNP (12766 vs. 4507 pg/ml; P<0.0001), cystatin C (1.68 vs. 1.12 mg/l; P=0.0001), and C-reactive protein (1.1 vs. 0.5 mg/dl; P = 0.04) and had a lower level of hemoglobin (10.8 vs. 12.2 g/dl; P = 0.0003) compared with those who did not. However, there was no significant difference in white blood cell count (7500 vs. 7800/μl) between these groups. In a multivariate Cox regression analysis including these biomarkers, age, sex, ischemic etiology, systolic blood pressure, heart rate, NYHA functional class, and LVEF, elevation (>median value) of TnT (>0.025 ng/ml; relative risk (RR) = 2.5, P = 0.01), NT-proBNP (>5776 pg/ml; RR = 2.9, P = 0.002), and cystatin C (>1.16 mg/l; RR = 3.6, P = 0.0005) was independently associated with cardiac death. The number of elevated biomarkers on admission correlated with an incremental increase in 1- and 12-month cardiac mortality rates (Table⇓).
Conclusions: TnT, NT-proBNP, and cystatin C each provide unique prognostic information in patients hospitalized for worsening CHF. A simple multimarker strategy that categorizes patients based on the number of elevated biomarkers on admission allows risk stratification for cardiac mortality within 12 months in this population.