Complementary Prognostic Value of Cystatin C, N-Terminal Pro-B-Type Natriuretic Peptide and Cardiac Troponin T in Patients With Acute Heart Failure

The aims of this study were to compare the prognostic value of cystatin C over creatinine and the Modification of Diet in Renal Disease (MDRD) equation and to evaluate whether it provides complementary information to cardiac biomarkers in the risk stratification of an unselected cohort of patients w...

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Bibliographic Details
Published in:The American journal of cardiology 2009-06, Vol.103 (12), p.1753-1759
Main Authors: Manzano-Fernández, Sergio, MD, Boronat-Garcia, Miguel, MD, Albaladejo-Otón, María Dolores, MD, Pastor, Patricia, MD, Garrido, Iris Paula, MD, Pastor-Pérez, Francisco Jose, MD, Martínez-Hernández, Pedro, MD, Valdés, Mariano, Prof, Pascual-Figal, Domingo Andres, PhD
Format: Article
Language:English
Subjects:
Acute Disease
Aged
Aged, 80 and over
Biological and medical sciences
Biomarkers
Biomarkers - blood
Cardiology
Cardiology. Vascular system
Cardiovascular
Confidence Intervals
Cystatin C - blood
Female
Follow-Up Studies
Heart
Heart failure
Heart Failure - blood
Heart Failure - mortality
Heart failure, cardiogenic pulmonary edema, cardiac enlargement
Humans
Immunoassay
Male
Medical prognosis
Medical sciences
Middle Aged
Mortality
Natriuretic Peptide, Brain - blood
Odds Ratio
Peptide Fragments - blood
Peptides
Prognosis
Prospective Studies
Protein Precursors
Risk Factors
Spain - epidemiology
Troponin T - blood
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Summary:The aims of this study were to compare the prognostic value of cystatin C over creatinine and the Modification of Diet in Renal Disease (MDRD) equation and to evaluate whether it provides complementary information to cardiac biomarkers in the risk stratification of an unselected cohort of patients with acute heart failure. Consecutive hospitalized patients with established diagnoses of acute heart failure were prospectively studied. Blood samples were collected on hospital arrival to determine cystatin C, cardiac troponin T, and N-terminal–pro-brain natriuretic peptide. Clinical follow-up was obtained, and the occurrence of mortality and/or heart failure readmission was registered. One hundred thirty-eight patients (median age 74 years, interquartile range 67 to 80; 54% men) were studied. During a median follow-up period of 261 days (interquartile range 161 to 449), 60 patients (43.5%) presented with adverse events. After multivariate adjustment, cystatin C, N-terminal–pro-brain natriuretic peptide, cardiac troponin T, New York Heart Association functional class III or IV, and diabetes mellitus were identified as independent predictors of mortality and/or heart failure readmission. In contrast to creatinine and the MDRD equation, the highest cystatin C tertile (>1.50 mg/L) was a significant independent risk factor for adverse events (hazard ratio 3.08, 95% confidence interval 1.54 to 6.14, p = 0.004). A multimarker approach combining cardiac troponin T, N-terminal–pro-brain natriuretic peptide, and cystatin C improved risk stratification further, showing that patients with 2 (hazard ratio 2.37, 95% confidence interval 1.10 to 5.71) or 3 (hazard ratio 3.64, 95% confidence interval 1.55 to 8.56) elevated biomarkers had a higher risk for adverse events than patients with no elevated biomarkers (p for trend = 0.015). In conclusion, in this unselected cohort, cystatin C was a stronger predictor of adverse events than conventional measures of kidney function. In addition, cystatin C offered complementary prognostic information to cardiac biomarkers and could help clinicians perform more accurate risk stratification of patients with acute heart failure.
ISSN:0002-9149
1879-1913
DOI:10.1016/j.amjcard.2009.02.029