Elevations in sST2, hsTnT, and NT-proBNP were independently predictive of all-cause mortality in ADHF, with each elevated marker tripling the risk of death (HR 2.64; 95% CI 1.63-4.28; P<0.001).
Cohort (n=107)
Does the combined measurement of sST2, hsTnT, and NT-proBNP improve risk stratification for mortality in patients hospitalized with acutely decompensated heart failure?
A multimarker approach combining sST2, hsTnT, and NT-proBNP provides superior and complementary risk stratification for mortality in patients with acutely decompensated heart failure.
Effect estimate: HR 2.64 (95% CI 1.63-4.28)
p-value: p=< 0.001
AIM: To investigate the use of biomarkers providing independent information regarding physiology in acutely decompensated heart failure (ADHF) for assessment of risk. METHODS AND RESULTS: This was a prospective study of 107 patients hospitalized with ADHF (mean age 72 ± 13 years, 44% male, left ventricular ejection fraction 47 ± 15%). Blood samples were collected on presentation to measure soluble (s)ST2, high-sensitivity troponin T (hsTnT), and amino-terminal pro-B type natriuretic peptide (NT-proBNP) levels. Clinical follow-up was obtained for all patients over a median period of 739 days, and all-cause mortality was registered. Concentrations of sST2 per 10 ng/mL, hazard ratio (HR) 1.09, 95% confidence interval (CI) 1.04-1.13; P< 0.001, hsTnT (per 0.1 ng/mL, HR 1.16, 95% CI 1.09-1.24; P< 0.001), and NT-proBNP (per 100 pg/mL, HR 1.01, 95% CI 1.003-1.01; P< 0.001) were each predictive of a higher risk of death. In bootstrapped models, each biomarker retained independent predictive value for mortality. Patients with all three biomarkers below their optimal cut-off at presentation were free of death (0%) during follow-up, whereas 53% of those with elevations of all three biomarkers had died. For each elevated marker (from 0 to 3) adjusted analysis suggested a tripling of the risk of death (for each elevated marker, HR 2.64, 95% CI 1.63-4.28, P< 0.001). Integrated discrimination analyses indicated that the use of these three markers in a multimarker approach uniquely improved prediction of death. CONCLUSIONS: Biomarkers reflecting remodelling (sST2), myonecrosis (hsTnT), and myocardial stretch (NT-proBNP) provide complementary prognostic information in patients with ADHF. When used together, these novel markers provide superior risk stratification.
Pascual‐Figal et al. (Fri,) conducted a cohort in acutely decompensated heart failure (ADHF) (n=107). Biomarkers (sST2, hsTnT, NT-proBNP) was evaluated on all-cause mortality (HR 2.64, 95% CI 1.63-4.28, p=< 0.001). Elevations in sST2, hsTnT, and NT-proBNP were independently predictive of all-cause mortality in ADHF, with each elevated marker tripling the risk of death (HR 2.64; 95% CI 1.63-4.28; P<0.001).