Key result
In patients with acute dyspnea, having 3 elevated biomarkers (NT-proBNP, hsTnT, and IGBFP7) was associated with a 12.6-fold increased risk of 180-day mortality or HF rehospitalization (P<0.001).
Why the study?
The optimal approach to interpreting elevated concentrations of NT-proBNP, high-sensitivity cardiac troponin T, and insulin-like growth factor binding protein-7 in patients presenting with acute dyspnea remains unknown.
Does the number of elevated biomarkers (NT-proBNP, hsTnT, IGFBP7) predict acute heart failure diagnosis and 180-day mortality or HF rehospitalization in patients presenting with acute dyspnea?
Observational (n=1,448)
Yes
Does the number of elevated biomarkers (NT-proBNP, hsTnT, IGFBP7) predict acute heart failure diagnosis and 180-day mortality or HF rehospitalization in patients presenting with acute dyspnea?
A multimarker panel of NT-proBNP, hsTnT, and IGFBP7 provides significant prognostic information for short-term mortality and HF rehospitalization in patients presenting with acute dyspnea.
Answers are grounded in this paper and cite their sources.
Biomarker elevation was associated with higher 180-day risk in acute dyspnea; hypothesis-generating for multi-marker panels in HF prognostication.
BACKGROUND: Among patients with acute dyspnea, concentrations of N-terminal pro-B-type natriuretic peptide (NT-proBNP), high-sensitivity cardiac troponin T, and insulin-like growth factor binding protein-7 predict cardiovascular outcomes and death. Understanding the optimal means to interpret these elevated biomarkers in patients presenting with acute dyspnea remains unknown. METHODS AND RESULTS: Concentrations of NT-proBNP, high-sensitivity cardiac troponin T, and insulin-like growth factor binding protein-7 were analyzed in 1448 patients presenting with acute dyspnea from the prospective, multicenter International Collaborative of NT-proBNP-Re-evaluation of Acute Diagnostic Cut-Offs in the Emergency Department (ICON-RELOADED) Study. Eight biogroups were derived based upon patterns in biomarker elevation at presentation and compared for differences in baseline characteristics. Of 441 patients with elevations in all 3 biomarkers, 218 (49.4%) were diagnosed with acute heart failure (HF). The frequency of acute HF diagnosis in this biogroup was higher than those with elevations in 2 biomarkers (18.8%, 44 of 234), 1 biomarker (3.8%, 10 of 260), or no elevated biomarkers (0.4%, 2 of 513). The absolute number of elevated biomarkers on admission was prognostic of the composite end point of mortality and HF rehospitalization. In adjusted models, patients with one, 2, and 3 elevated biomarkers had 3.74 (95% confidence interval [CI], 1.26-11.1, P = .017), 12.3 (95% CI, 4.60-32.9, P < .001), and 12.6 (95% CI, 4.54-35.0, P < .001) fold increased risk of 180-day mortality or HF rehospitalization. CONCLUSIONS: A multimarker panel of NT-proBNP, hsTnT, and IGBFP7 provides unique clinical, diagnostic, and prognostic information in patients presenting with acute dyspnea. Differences in the number of elevated biomarkers at presentation may allow for more efficient clinical risk stratification of short-term mortality and HF rehospitalization.
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Abboud et al. (2021) conducted an observational in Acute dyspnea (n=1,448). Elevation of 3 biomarkers (NT-proBNP, hsTnT, and IGBFP7) vs. No elevated biomarkers was evaluated on Composite of 180-day mortality or HF rehospitalization (12.6-fold increased risk, 95% CI 4.54-35.0, p=<.001). In patients with acute dyspnea, having 3 elevated biomarkers (NT-proBNP, hsTnT, and IGBFP7) was associated with a 12.6-fold increased risk of 180-day mortality or HF rehospitalization (P<0.001).
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