A multimarker multi-time point-based risk stratification strategy in acute heart failure: results from the RELAX-AHF trial.

Autor:	Demissei BG; Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.; Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands., Cotter G; Momentum Research, Durham, NC, USA., Prescott MF; Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA., Felker GM; Duke Clinical Research Institute, Durham, NC, USA., Filippatos G; Athens University Hospital, Attikon, Athens, Greece., Greenberg BH; University of California at San Diego, San Diego, CA, USA., Pang PS; Indiana University School of Medicine, Indianapolis, IN, USA., Ponikowski P; Medical University, Clinical Military Hospital, Wroclaw, Poland., Severin TM; Novartis Pharma AG, Basel, Switzerland., Wang Y; Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA., Qian M; Department of Biostatistics, Columbia University, New York, NY, USA., Teerlink JR; University of California at San Francisco and San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA., Metra M; University of Brescia, Brescia, Italy., Davison BA; Momentum Research, Durham, NC, USA., Voors AA; Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Jazyk:	angličtina
Zdroj:	European journal of heart failure [Eur J Heart Fail] 2017 Aug; Vol. 19 (8), pp. 1001-1010. Date of Electronic Publication: 2017 Jan 30.
DOI:	10.1002/ejhf.749
Abstrakt:	Aims: We evaluated the added prognostic value of a multi-time point-based multimarker panel of biomarkers in patients with acute heart failure (AHF). Methods and Results: Seven circulating biomarkers [NT-proBNP, high sensitivity cardiac troponin T (hs-cTnT), soluble ST2 (sST2), growth differentiation factor 15 (GDF-15), cystatin-C, galectin-3, and high sensitivity C-reactive protein (hs-CRP)] were measured at baseline and on days 2, 5, 14, and 60 in 1161 patients enrolled in the RELAX-AHF trial. Patients with BNP ≥350 ng/L or NT-proBNP ≥1400 ng/L, mild to moderate renal impairment, and systolic blood pressure >125 mmHg were included in the trial. Time-dependent Cox regression analysis was utilized to evaluate the incremental value of serial measurement of biomarkers. Added value of individual biomarkers and their combination, on top of a pre-specified baseline model, was quantified with the gain in the C-index. Serial biomarker evaluation showed incremental predictive value over baseline measurements alone for the prediction of 180-day cardiovascular mortality except for galectin-3. While a repeat measurement as early as day 2 was adequate for NT-proBNP and cystatin-C in terms of maximizing discriminatory accuracy, further measurements on days 14 and 60 provided added value for hs-cTnT, GDF-15, sST2, and hs-CRP. Individual biomarker additions on top of the baseline model showed additional prognostic value. The greatest prognostic gain was, however, attained with the combination of NT-proBNP, hs-cTnT, GDF-15, and sST2, which yielded 0.08 unit absolute increment in the C-index to 0.87 (95% confidence interval 0.83-0.91]. Conclusion: In patients with AHF and mild to moderate renal impairment, a multimarker approach based on a panel of serially evaluated biomarkers provides the greatest prognostic improvement unmatched by a single time point-based single marker strategy. (© 2017 The Authors. European Journal of Heart Failure © 2017 European Society of Cardiology.)
Databáze:	MEDLINE
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