학술논문
Multiple Cardiac Biomarker Testing Among Patients With Acute Dyspnea From the ICON-RELOADED Study.
Document Type
Academic Journal
Author
Abboud A; From the Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.; Kui N; Baim Institute for Clinical Research, Boston, Massachusetts.; Gaggin HK; From the Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.; Ibrahim NE; INOVA Heart and Vascular Institute, Falls Church, Virginia.; Chen-Tournoux AA; Azrieli Heart Centre, Jewish General Hospital, Montreal, PQ, Canada.; Christenson RH; University of Maryland School of Medicine, Baltimore, Maryland.; Hollander JE; Thomas Jefferson University, Philadelphia, Pennsylvania.; Levy PD; Wayne State University, Detroit, Michigan.; Nagurney JT; From the Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.; Nowak RM; Henry Ford Health System, Detroit, Michigan.; Pang PS; Indiana University School of Medicine & Indianapolis EMS, Indianapolis, Indiana.; Peacock WF; Baylor College of Medicine, Houston, Texas.; Walters EL; Loma Linda University Medical Center, Loma Linda, California.; Januzzi JL; From the Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Baim Institute for Clinical Research, Boston, Massachusetts. Electronic address: jjanuzzi@partners.org.
Source
Publisher: Churchill Livingstone Country of Publication: United States NLM ID: 9442138 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1532-8414 (Electronic) Linking ISSN: 10719164 NLM ISO Abbreviation: J Card Fail Subsets: MEDLINE
Subject
Language
English
Abstract
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.
(Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.)
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.
(Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.)