John G F Cleland1,2, John R Teerlink3, Beth A Davison4, Ahmad Shoaib1, Marco Metra5, Stefanie Senger4, Olga Milo4, Gad Cotter4, Robert C Bourge6, John D Parker7, Guillaume Jondeau8, Henry Krum9, Christopher M O'Connor10, Guillermo Torre-Amione11, Dirk J van Veldhuisen12, John J V McMurray13. 1. University of Hull, Kingston upon Hull, UK. 2. National Heart and Lung Institute, Royal Brompton and Harefield Hospitals NHS Trust, Imperial College, London, UK. 3. University of California, San Francisco and the San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA. 4. Momentum Research, Inc., Durham, NC, USA. 5. University of Brescia, Piazza Spedali Civili, Brescia, Italy. 6. University of Alabama at Birmingham, Birmingham, AL, USA. 7. Division of Cardiology, Mount Sinai Hospital, Toronto, Ontario, Canada. 8. Service de Cardiologie, Hôpital Bichat, Paris, France. 9. Monash Centre of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Alfred Hospital, Monash University, Melbourne, Australia (deceased 28 November 2015). 10. Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA. 11. Methodist DeBakey Heart and Vascular Center, The Methodist Hospital, Houston, Texas, USA. 12. University Medical Centre, Groningen, the Netherlands. 13. University of Glasgow, Glasgow, UK.
Abstract
OBJECTIVE:Plasma concentrations of B-type natriuretic peptide (BNP) and troponin are often measured for diagnostic purposes when patients are admitted with heart failure, but their prognostic value when measured soon after admission is uncertain. We aimed to investigate the added prognostic value of admission measurements of BNP and troponins in patients with acute heart failure. METHODS AND RESULTS: Multivariable prognostic models for death or any worsening heart failure (WHF) or rehospitalization for WHF by 30 days, 30-day death or rehospitalization for WHF, and 90-day mortality were constructed using baseline data from the Value of Endothelin Receptor Inhibition with Tezosentan in Acute heart failure Studies (VERITAS) including BNP and troponin I. Of 1347 patients, the median (interquartile range) value of BNP was 422 (156-945) pg/mL and 855 (63%) had measurable troponin I. By 30 days, 432 patients had died or experienced WHF. Clinical variables had only moderate predictive performance that was not substantially improved by BNP or troponin I (c-indices 0.6528 and 0.6595, respectively). By 30 days, 150 patients died or were rehospitalized for WHF. The c-index using clinical variables (0.6855) was not improved by adding biomarkers. By 90 days, 135 patients had died. The c-index for mortality was somewhat better than for composite outcomes (0.7394) but improved little with biomarkers (0.7461). CONCLUSION: Routine clinical data recorded at the time of admission in patients with acute heart failure are poor at predicting recurrent admissions but somewhat better at predicting mortality. Neither BNP nor troponin measured at admission improved predictions; measurement closer to discharge, or of other novel biomarkers, might perform differently.
RCT Entities:
OBJECTIVE: Plasma concentrations of B-type natriuretic peptide (BNP) and troponin are often measured for diagnostic purposes when patients are admitted with heart failure, but their prognostic value when measured soon after admission is uncertain. We aimed to investigate the added prognostic value of admission measurements of BNP and troponins in patients with acute heart failure. METHODS AND RESULTS: Multivariable prognostic models for death or any worsening heart failure (WHF) or rehospitalization for WHF by 30 days, 30-day death or rehospitalization for WHF, and 90-day mortality were constructed using baseline data from the Value of Endothelin Receptor Inhibition with Tezosentan in Acute heart failure Studies (VERITAS) including BNP and troponin I. Of 1347 patients, the median (interquartile range) value of BNP was 422 (156-945) pg/mL and 855 (63%) had measurable troponin I. By 30 days, 432 patients had died or experienced WHF. Clinical variables had only moderate predictive performance that was not substantially improved by BNP or troponin I (c-indices 0.6528 and 0.6595, respectively). By 30 days, 150 patients died or were rehospitalized for WHF. The c-index using clinical variables (0.6855) was not improved by adding biomarkers. By 90 days, 135 patients had died. The c-index for mortality was somewhat better than for composite outcomes (0.7394) but improved little with biomarkers (0.7461). CONCLUSION: Routine clinical data recorded at the time of admission in patients with acute heart failure are poor at predicting recurrent admissions but somewhat better at predicting mortality. Neither BNP nor troponin measured at admission improved predictions; measurement closer to discharge, or of other novel biomarkers, might perform differently.
Authors: Roger Hullin; Nicolas Barras; Tamila Abdurashidova; Pierre Monney; Julien Regamey Journal: Intern Emerg Med Date: 2018-12-13 Impact factor: 3.397
Authors: Gregory J Wehner; Linyuan Jing; Christopher M Haggerty; Jonathan D Suever; Joseph B Leader; Dustin N Hartzel; H Lester Kirchner; Joseph N A Manus; Nick James; Zina Ayar; Patrick Gladding; Christopher W Good; John G F Cleland; Brandon K Fornwalt Journal: Eur Heart J Date: 2020-03-21 Impact factor: 29.983
Authors: Jeffrey P Jacobs; Shama S Alam; Sherry L Owens; Devin M Parker; Michael Rezaee; Donald S Likosky; David M Shahian; Marshall L Jacobs; Heather Thiessen-Philbrook; Moritz Wyler von Ballmoos; Kevin Lobdell; Todd MacKenzie; Allen D Everett; Chirag R Parikh; Jeremiah R Brown Journal: Ann Thorac Surg Date: 2018-06-01 Impact factor: 4.330
Authors: Meaghan Lunney; Marinella Ruospo; Patrizia Natale; Robert R Quinn; Paul E Ronksley; Ioannis Konstantinidis; Suetonia C Palmer; Marcello Tonelli; Giovanni Fm Strippoli; Pietro Ravani Journal: Cochrane Database Syst Rev Date: 2020-02-27
Authors: Cassandra Freitas; Xuesong Wang; Yin Ge; Heather J Ross; Peter C Austin; Peter S Pang; Dennis T Ko; Michael E Farkouh; Therese A Stukel; John J V McMurray; Douglas S Lee Journal: CJC Open Date: 2020-02-24
Authors: Christophe J P Smeets; Seulki Lee; Willemijn Groenendaal; Gabriel Squillace; Julie Vranken; Hélène De Cannière; Chris Van Hoof; Lars Grieten; Wilfried Mullens; Petra Nijst; Pieter M Vandervoort Journal: JMIR Cardio Date: 2020-03-18