Measurement of troponin and natriuretic peptides shortly after admission in patients with heart failure—does it add useful prognostic information? An analysis of the Value of Endothelin Receptor Inhibition with Tezosentan in Acute heart failure Studies (VERITAS)

• Published in: European journal of heart failure Vol. 19; no. 6; pp. 739 - 747
• Main Authors: Cleland, John G.F., Teerlink, John R., Davison, Beth A., Shoaib, Ahmad, Metra, Marco, Senger, Stefanie, Milo, Olga, Cotter, Gad, Bourge, Robert C., Parker, John D., Jondeau, Guillaume, Krum, Henry, O'Connor, Christopher M., Torre‐Amione, Guillermo, van Veldhuisen, Dirk J., McMurray, John J.V.
• Format: Journal Article
• Language: English
• Published: Oxford, UK John Wiley & Sons, Ltd 01.06.2017
• Subjects: Acute Disease; Acute heart failure; Aged; Biomarkers; Biomarkers - blood; Dose-Response Relationship, Drug; Europe - epidemiology; Female; Follow-Up Studies; Heart Failure - blood; Heart Failure - drug therapy; Heart Failure - mortality; Hospital Mortality - trends; Humans; Injections, Intravenous; Male; Middle Aged; Natriuretic Peptide, Brain - blood; Patient Admission; Patient Discharge - trends; Prognosis; Pyridines - administration & dosage; Receptors, Endothelin - blood; Receptors, Endothelin - drug effects; Retrospective Studies; Statistical models; Survival Rate - trends; Tetrazoles - administration & dosage; Time Factors; Troponin I - blood; United States - epidemiology; Vasodilator Agents - administration & dosage; Biomarkers; Prognosis; Statistical models; Acute heart failure
• ISSN: 1388-9842; 1879-0844
• DOI: 10.1002/ejhf.786

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.