Utility of Amino-Terminal Pro-Brain Natriuretic Peptide, Galectin-3, and Apelin for the Evaluation of Patients With Acute Heart Failure

• Published in: Journal of the American College of Cardiology Vol. 48; no. 6; pp. 1217 - 1224
• Main Authors: van Kimmenade, Roland R., Januzzi, James L., Ellinor, Patrick T., Sharma, Umesh C., Bakker, Jaap A., Low, Adrian F., Martinez, Abelardo, Crijns, Harry J., MacRae, Calum A., Menheere, Paul P., Pinto, Yigal M.
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 19.09.2006; Elsevier Science; Elsevier Limited
• Subjects: Acute Disease; Age; Aged; Aged, 80 and over; Apelin; Biological and medical sciences; Biomarkers - blood; Cardiology; Cardiology. Vascular system; Cardiomyopathy; Cardiovascular; Cardiovascular disease; Classification; Confidence intervals; Diabetes; Dyspnea - blood; Enzymes; Family medical history; Female; Galectin 3 - blood; Heart; Heart attacks; Heart failure; Heart Failure - blood; Heart Failure - diagnosis; Heart Failure - mortality; Heart failure, cardiogenic pulmonary edema, cardiac enlargement; Humans; Hypertension; Intercellular Signaling Peptides and Proteins - blood; Male; Medical prognosis; Medical sciences; Middle Aged; Mortality; Multivariate analysis; Natriuretic Peptide, Brain - blood; Osmolar Concentration; Peptide Fragments - blood; Peptides; Prognosis; Rodents; Survival Analysis; Time Factors; NYHA; gal; NT-proBNP; OR; BNP; PRIDE; CI; CAD; ROC; IQR; HF; AUC; coronary artery disease; heart failure; brain natriuretic peptide; area under the curve; interquartile range; odds ratio; amino-terminal pro-brain natriuretic peptide; New York Heart Association; galectin; N-Terminal Pro-BNP Investigation of Dyspnea in the Emergency Department; confidence interval; receiver operating characteristic; Galectin; Human; Heart failure; Evaluation; Brain natriuretic peptide; Heart disease; Acute; Cardiovascular disease; Circulatory system; Cardiology; Phlebology; Aminoacid sequence
• ISSN: 0735-1097; 1558-3597; 1558-3597
• DOI: 10.1016/j.jacc.2006.03.061

Utility of Amino-Terminal Pro-Brain Natriuretic Peptide, Galectin-3, and Apelin for the Evaluation of Patients With Acute Heart Failure Roland R. van Kimmenade, James L. Januzzi, Jr, Patrick T. Ellinor, Umesh C. Sharma, Jaap A. Bakker, Adrian F. Low, Abelardo Martinez, Harry J. Crijns, Calum A. MacRae, Paul P. Menheere, Yigal M. Pinto This study investigated the utility of apelin and galectin-3 alone or together with amino-terminal pro-brain natriuretic peptide (NT-proBNP) for short-term prognosis in acute heart failure (HF). Serum concentrations were measured in 599 patients presenting with dyspnea at the emergency department, of which 209 (35%) had acute HF. Receiver operating characteristic analysis showed that galectin-3 had the greatest area under the curve (AUC) for prognosis (AUC = 0.74) when compared with NT-proBNP and apelin (AUC = 0.67 and 0.54). An elevated level of galectin-3 was the best independent predictor of death/recurrent HF within 60 days (odds ratio 14.3, p < 0.001), but the combination of elevated galectin-3 and NT-proBNP was an even stronger predictor. This study sought to explore the role of new biomarkers in heart failure (HF). We investigated the utility of novel serum markers alone or together with natriuretic peptide testing for diagnosis and short-term prognosis estimation in subjects with acute HF. Plasma levels of amino-terminal pro-brain natriuretic peptide (NT-proBNP), apelin, and galectin-3 were measured in 599 patients presenting with dyspnea at the emergency department, of which 209 (35%) had acute HF. The NT-proBNP was superior to either apelin or galectin-3 for diagnosis of acute HF, although galectin-3 levels were significantly higher in subjects with HF compared with those without. Receiver operating characteristic analysis for mortality prediction showed that, for 60-day prognosis, galectin-3 had the greatest area under the curve (AUC) at 0.74 (p = 0.0001), whereas NT-proBNP and apelin had an AUC of 0.67 (p = 0.009) and 0.54 (p = 0.33). In a multivariate logistic regression analysis, an elevated level of galectin-3 was the best independent predictor of 60-day mortality (odds ratio 10.3, p < 0.01) or the combination of death/recurrent HF within 60 days (odds ratio 14.3, p < 0.001). The Kaplan-Meier analyses showed that the combination of an elevated galectin-3 with NT-proBNP was a better predictor of mortality than either of the 2 markers alone. Our data show potential utility of galectin-3 as a useful marker for evaluation of patients with suspected or proven acute HF, whereas apelin measurement was not useful for these indications. Moreover, the combination of galectin-3 with NT-proBNP was the best predictor for prognosis in subjects with acute HF.