Journal: Circ J 72(11):1800 1805, 2008. 22 References
Reprint: First Department of Internal Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima 960-1295, Japan (Y Takeishi, MD)
Faculty Disclosure: Abstracted by S. Ouellette, who has nothing to disclose.
Chronic heart failure (CHF) is a major cause of death and hospitalization. The prognostic evaluation and risk stratification of CHF patients continues to increase in importance and involves a complex assessment of multiple interacting variables. Several new markers have emerged as a strong predictor of risk among CHF patients. These markers are divided into three groups: neurohormonal markers that reveal pressure and/or volume overload; markers of myocardial damage; and markers of inflammation. B-type natriuretic peptide (BNP) is secreted from the ventricles by mechanical overload and is the established marker of neurohormonal factors. Heart-type fatty acid-binding protein (H-FABP) is a marker of ongoing myocardial cell injury, and pentraxin 3 (PTX3) is a marker of inflammation. The purpose of this study was to evaluate the combination of all three markers in stratifying risk in patients with CHF.
Levels of BNP (associated with left ventricular dysfunction, positive if >200 pg/mL), H-FABP (marker of myocardial damage, positive if >4.1 ng/mL), and PTX3 (marker of inflammation, positive if >4.0 ng/mL) were measured in 164 consecutive CHF patients. These patients were prospectively followed with endpoints of cardiac death or rehospitalization. When patients were categorized on the basis of the number of elevated biomarkers, patients with 1, 2, and 3 elevated biomarkers had a 5.4-fold (not significant), 11.2-fold and 34.6-fold increase, respectively, in the risk of adverse cardiac events compared with those without elevated biomarkers. Kaplan-Meier analysis revealed that patients with 3 elevated biomarkers had a significantly higher cardiac event rate than patients with a lower number of elevated biomarkers. The combination of these 3 biomarkers could reliably risk-stratify CHF patients for prediction of cardiac events. |
