Abstract 15368: Prognostic Value Of Inflammatory, Extracellular Matrix And Necrosis Biomarkers, And Their Relationship With Neurohormonal Biomarkers And Outcome In Patients With Acute Heart Failure. Data From The Everest Trial
Objectives: Inflammation, extracellular matrix (ECM) turnover and cell injury are involved in the pathophysiology of acute heart failure (AHF), at least partly as a result of neurohormonal activation. We aimed to assess the role of biomarkers, for risk stratification in patients with AHF.
Methods: We performed a substudy of 230 patients from the EVEREST trial, which assessed the effect of the vasopressin receptor blocker tolvaptan in patients with AHF. High-sensitivity C-reactive proteine (HS-CRP), type I Collagen telopeptide (ICTP), and cardiac troponin I (c-TnI) were selected as biomarkers of inflammation, ECM turnover and cell injury, respectively. Aldosterone, vasopressin and brain natriuretic peptide (BNP) were selected as biomarkers of neurohormonal activation. We assessed the association of HS-CRP, ICTP, and c-TnI with clinical variables at baseline, and second, their association with clinical outcomes. Cox regression models were fit to assess the association between HS-CRP, ICTP, c-TnI and clinical outcomes, adjusting for the most predictive clinical variables or neurohormonal biomarkers.
Results: At baseline, ICTP level was associated with clinical markers of disease severity, such as NYHA class, Jugular venous distension (JVD>10), serum creatinine and previous hospitalization (all p≤0.01). Hs-CRP (but not c-TnI) was associated with clinical markers of disease severity, including JVD>10 (p=0.02) and NYHA class (p<0.01). Univariately, ICTP was significantly associated with time to all clinical outcomes (All-cause mortality, CV mortality, CV mortality or HF hospitalization, and HF hospitalization), while HS-CRP and c-TnI were not associated with outcomes. However, after adjusting for JVD>10, ICTP was only associated with all-cause mortality (HR 1.06; 1.01-1.10). After adjusting only for BNP, ICTP was no longer associated with clinical outcomes.
Conclusion: Inflammation and collagen degradation but not cell injury biomarkers were associated with disease severity in AHF patients. ICTP but not HS-CRP or c-TnI was predictive of clinical outcomes. However, ICTP does not appear to add to the predictive value of BNP. Its role for risk stratification and as a therapeutic target in AHF patients needs further investigation.
- © 2011 by American Heart Association, Inc.