Key result
cMyC accurately diagnoses AHF and above-median levels predict ~119% higher 360-day mortality.
Why the study?
cMyC seems more sensitive than high-sensitivity cardiac troponin in quantifying cardiomyocyte injury, suggesting potential diagnostic and prognostic utility.
Does cardiac myosin-binding protein C (cMyC) improve the diagnosis of acute heart failure and predict mortality in patients presenting with acute dyspnoea?
Observational (n=1,083)
Blinded
Yes
Does cardiac myosin-binding protein C (cMyC) improve the diagnosis of acute heart failure and predict mortality in patients presenting with acute dyspnoea?
Effect estimate: AUC 0.81 (95% CI 0.78-0.83)
cMyC provides high diagnostic accuracy for acute heart failure and independently predicts 1-year mortality, though its diagnostic AUC is lower than NT-proBNP.
May support cMyC evaluation in acute dyspnoea; leaves open incremental value over NT-proBNP pending validation.
AIMS: Cardiac myosin-binding protein C (cMyC) seems to be even more sensitive in the quantification of cardiomyocyte injury vs. high-sensitivity cardiac troponin, and may therefore have diagnostic and prognostic utility. METHODS AND RESULTS: In a prospective multicentre diagnostic study, cMyC, high-sensitivity cardiac troponin T (hs-cTnT), and N-terminal pro-B-type natriuretic peptide (NT-proBNP) plasma concentrations were measured in blinded fashion in patients presenting to the emergency department with acute dyspnoea. Two independent cardiologists centrally adjudicated the final diagnosis. Diagnostic accuracy for acute heart failure (AHF) was quantified by the area under the receiver operating characteristic curve (AUC). All-cause mortality within 360 days was the prognostic endpoint. Among 1083 patients eligible for diagnostic analysis, 51% had AHF. cMyC concentrations at presentation were higher among AHF patients vs. patients with other final diagnoses [72 (interquartile range, IQR 39-156) vs. 22 ng/L (IQR 12-42), P < 0.001)]. cMyC's AUC was high [0.81, 95% confidence interval (CI) 0.78-0.83], higher than hs-cTnT's (0.79, 95% CI 0.76-0.82, P = 0.081) and lower than NT-proBNP's (0.91, 95% CI 0.89-0.93, P < 0.001). Among 794 AHF patients eligible for prognostic analysis, 28% died within 360 days; cMyC plasma concentrations above the median indicated increased risk of death (hazard ratio 2.19, 95% CI 1.66-2.89; P < 0.001). cMyC's prognostic accuracy was comparable with NT-proBNP's and hs-cTnT's. cMyC did not independently predict all-cause mortality when used in validated multivariable regression models. In novel multivariable regression models including medication, age, left ventricular ejection fraction, and discharge creatinine, cMyC remained an independent predictor of death and had no interactions with medical therapies at discharge. CONCLUSION: Cardiac myosin-binding protein C may aid physicians in the rapid triage of patients with suspected AHF.
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Kozhuharov et al. (2021) conducted an observational in Acute dyspnoea / suspected acute heart failure (n=1,083). Cardiac myosin-binding protein C (cMyC) vs. hs-cTnT and NT-proBNP was evaluated on Diagnostic accuracy for acute heart failure (AHF) (AUC 0.81, 95% CI 0.78-0.83). Cardiac myosin-binding protein C demonstrated high diagnostic accuracy for acute heart failure (AUC 0.81; 95% CI 0.78-0.83) and concentrations above the median predicted 360-day mortality (HR 2.19).
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