AimTo investigate the use of biomarkers providing independent information regarding physiology in acutely decompensated heart failure (ADHF) for assessment of risk.Methods and resultsThis was a prospective study of 107 patients hospitalized with ADHF (mean age 72 ± 13 years, 44 male, left ventricular ejection fraction 47 ± 15). Blood samples were collected on presentation to measure soluble (s)ST2, high-sensitivity troponin T (hsTnT), and amino-terminal pro-B type natriuretic peptide (NT-proBNP) levels. Clinical follow-up was obtained for all patients over a median period of 739 days, and all-cause mortality was registered. Concentrations of sST2 [per 10 ng/mL, hazard ratio (HR) 1.09, 95 confidence interval (CI) 1.041.13; P< 0.001], hsTnT (per 0.1 ng/mL, HR 1.16, 95 CI 1.091.24; P< 0.001), and NT-proBNP (per 100 pg/mL, HR 1.01, 95 CI 1.0031.01; P< 0.001) were each predictive of a higher risk of death. In bootstrapped models, each biomarker retained independent predictive value for mortality. Patients with all three biomarkers below their optimal cut-off at presentation were free of death (0) during follow-up, whereas 53 of those with elevations of all three biomarkers had died. For each elevated marker (from 0 to 3) adjusted analysis suggested a tripling of the risk of death (for each elevated marker, HR 2.64, 95 CI 1.634.28, P< 0.001). Integrated discrimination analyses indicated that the use of these three markers in a multimarker approach uniquely improved prediction of death.ConclusionsBiomarkers reflecting remodelling (sST2), myonecrosis (hsTnT), and myocardial stretch (NT-proBNP) provide complementary prognostic information in patients with ADHF. When used together, these novel markers provide superior risk stratification. © 2011 The Author.
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