Steffen Blum1, Stefanie Aeschbacher1, Pascal Meyre1, Michael Kühne1, Nicolas Rodondi2, Jürg H Beer3, Peter Ammann4, Giorgio Moschovitis5, Leo H Bonati6, Manuel R Blum2, Peter Kastner7, Fiona Baguley8, Christian Sticherling1, Stefan Osswald1, David Conen9. 1. Division of Cardiology, Department of Medicine, University Hospital Basel, University of Basel, Basel, Switzerland; Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland. 2. Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland; Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland. 3. Department of Medicine, Cantonal Hospital of Baden and Molecular Cardiology, University Hospital of Zurich, Switzerland. 4. Division of Cardiology, Kantonsspital St. Gallen, St. Gallen, Switzerland. 5. Division of Cardiology, EOC Ospedale Regionale di Lugano, Ticino, Switzerland. 6. Department of Neurology and Stroke Center, University Hospital Basel, University of Basel, Basel, Switzerland. 7. Roche Diagnostics GmbH, Penzberg, Germany. 8. Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland. 9. Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland; Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada. Electronic address: conend@mcmaster.ca.
Abstract
BACKGROUND: The occurrence of congestive heart failure (CHF) hospitalization among patients with atrial fibrillation (AF) is a poor prognostic marker. OBJECTIVE: The purpose of this study was to assess whether insulin-like growth factor-binding protein 7 (IGFBP-7), a marker of myocardial damage, identifies AF patients at high risk for this complication. METHODS: We analyzed 2 prospective multicenter observational cohort studies that included 3691 AF patients. Levels of IGFBP-7 and N-terminal pro-brain natriuretic peptide (NT-proBNP) were measured from frozen plasma samples at baseline. The primary endpoint was hospitalization for CHF. Multivariable adjusted Cox regression analyses were constructed. RESULTS: Mean patient age was 69 ± 12 years, 1028 (28%) were female, and 879 (24%) had a history of CHF. The incidence per 1000 patient-years across increasing IGFBP-7 quartiles was 7, 10, 32, and 85. The corresponding multivariable adjusted hazard ratios (aHRs) (95% confidence interval [CI]) were 1.0, 1.05 (0.63-1.77), 2.38 (1.50-3.79), and 4.37 (2.72-7.04) (P for trend <.001). In a subgroup of 2812 patients without pre-existing CHF at baseline, the corresponding aHRs were 1.0, 0.90 (0.47-1.72), 1.69 (0.94-3.04), and 3.48 (1.94-6.24) (P for trend <.001). Patients with IGFBP-7 and NT-proBNP levels above the biomarker-specific median had a higher risk of incident CHF hospitalization (aHR 5.20; 3.35-8.09) compared to those with only 1 elevated marker (elevated IGFBP-7 aHR 2.17; 1.30-3.60); elevated NT-proBNP aHR 1.97; 1.17-3.33); or no elevated marker (reference). CONCLUSION: Higher plasma levels of IGFBP-7 were strongly and independently associated with CHF hospitalization in AF patients. The prognostic information provided by IGFBP-7 was additive to that of NT-proBNP.
BACKGROUND: The occurrence of congestive heart failure (CHF) hospitalization among patients with atrial fibrillation (AF) is a poor prognostic marker. OBJECTIVE: The purpose of this study was to assess whether insulin-like growth factor-binding protein 7 (IGFBP-7), a marker of myocardial damage, identifies AF patients at high risk for this complication. METHODS: We analyzed 2 prospective multicenter observational cohort studies that included 3691 AF patients. Levels of IGFBP-7 and N-terminal pro-brain natriuretic peptide (NT-proBNP) were measured from frozen plasma samples at baseline. The primary endpoint was hospitalization for CHF. Multivariable adjusted Cox regression analyses were constructed. RESULTS: Mean patient age was 69 ± 12 years, 1028 (28%) were female, and 879 (24%) had a history of CHF. The incidence per 1000 patient-years across increasing IGFBP-7 quartiles was 7, 10, 32, and 85. The corresponding multivariable adjusted hazard ratios (aHRs) (95% confidence interval [CI]) were 1.0, 1.05 (0.63-1.77), 2.38 (1.50-3.79), and 4.37 (2.72-7.04) (P for trend <.001). In a subgroup of 2812 patients without pre-existing CHF at baseline, the corresponding aHRs were 1.0, 0.90 (0.47-1.72), 1.69 (0.94-3.04), and 3.48 (1.94-6.24) (P for trend <.001). Patients with IGFBP-7 and NT-proBNP levels above the biomarker-specific median had a higher risk of incident CHF hospitalization (aHR 5.20; 3.35-8.09) compared to those with only 1 elevated marker (elevated IGFBP-7 aHR 2.17; 1.30-3.60); elevated NT-proBNP aHR 1.97; 1.17-3.33); or no elevated marker (reference). CONCLUSION: Higher plasma levels of IGFBP-7 were strongly and independently associated with CHF hospitalization in AF patients. The prognostic information provided by IGFBP-7 was additive to that of NT-proBNP.
Authors: Elena Palà; Alejandro Bustamante; Jorge Pagola; Jesus Juega; Jaume Francisco-Pascual; Anna Penalba; Maite Rodriguez; Mercedes De Lera Alfonso; Juan F Arenillas; Juan Antonio Cabezas; Soledad Pérez-Sánchez; Francisco Moniche; Reyes de Torres; Teresa González-Alujas; Josep Lluís Clúa-Espuny; Juan Ballesta-Ors; Domingo Ribas; Juan Acosta; Alonso Pedrote; Felipe Gonzalez-Loyola; Delicia Gentile Lorente; Miguel Ángel Muñoz; Carlos A Molina; Joan Montaner Journal: Front Cardiovasc Med Date: 2022-07-04