Abstract 17498: Prognostic Importance of Novel Cardiac and Renal Biomarkers in Patients With Heart Failure, Reduced Ejection Fraction and Anemia
Background: B-type natriuretic peptides add further prognostic information to standard risk markers in heart failure. Whether other biomarkers provide additional predictive information is uncertain. We tested the incremental prognostic value of novel cardiac and renal biomarkers in the Reduction of Events by Darbepoetin Alfa in Heart Failure trial (RED-HF).
Methods: NT-proBNP, copeptin, cystatin-C, high-sensitivity CRP, mid-regional pro adrenomedullin (MR proADM), and troponin T (TnT) were measured in 2278 patients in RED-HF. The incremental predictive value of each biomarker added to standard clinical risk markers (age, sex, LVEF, NYHA class, diabetes, systolic BP etc. - “basic clinical model”) was calculated using Cox multivariable regression and c-statistics for all-cause mortality (ACM). The value of a multimarker prognostic strategy was also assessed using all biomarkers together.
Results: The hazard ratio (HR) for ACM per log standard deviation (SD) difference for each biomarker was as follows: NT-proBNP 2.31 (95%CI 2.04, 2.61), copeptin 1.65 (1.43, 1.89), cystatin C 1.73 (1.51, 1.98), hs-CRP 1.25 (1.14, 1.38), MR proADM 1.87 (1.68, 2.08), and TnT 2.08 (1.86, 2.31) (all p<0.001). The c-statistic increased from 0.652 for the basic clinical model to 0.699, 0.666, 0.666, 0.657, 0.682 and 0.694, respectively, with each biomarker added individually. When all biomarkers were considered together, the HRs per log standard deviation (SD) difference were: NT-proBNP 1.60 (1.38, 1.86), copeptin 1.09 (0.94, 1.27), cystatin C 1.05 (0.90, 1.22), hs-CRP 1.04 (0.97, 1.12), MR proADM 1.26 (1.09, 1.47) and TnT 1.48 (1.29, 1.69); only NT-proBNP and TnT (both p<0.001) and MR proADM (p=0.003) remained significant. The c-statistic for the multimarker model was 0.715 which was significantly greater than for the basic clinical model plus NT proBNP alone (P=0.002).
Conclusion: In RED-HF, novel cardiac and renal biomarkers individually added prognostic information to conventional risk predictors. In a multimarker strategy only NT-proBNP troponin T and MR proADM provided incremental information. The multimarker model was superior to the basic clinical model plus best individual biomarker (NT proBNP).
Author Disclosures: P. Welsh: None. C. Yu: None. J. McMurray: None. I.S. Anand: None. N. Sattar: None. D.J. van Veldhuisen: None. L. Gullestad: None. A.P. Maggioni: None. A.S. Desai: None. S.D. Solomon: None. S. Cheng: Employment; Significant; Employment. M.A. Pfeffer: None. L. Kou: None. K. Swedberg: None. J.B. Young: None.
- © 2014 by American Heart Association, Inc.