Serial biomarker measurements in ambulatory patients with chronic heart failure: The importance of change over time

Wayne L. Miller, Karen A. Hartman, Mary F. Burritt, Diane E. Grill, Richard J. Rodeheffer, John C Jr. Burnett, Allan S Jaffe

Research output: Contribution to journalArticle

154 Citations (Scopus)

Abstract

BACKGROUND - Cardiac troponin T (cTnT) and B-type natriuretic peptide (BNP) have been used to estimate prognosis in heart failure; however, most studies have evaluated decompensated patients with single measurements. To determine if there are advantages to serial measurements, we evaluated stable chronic heart failure patients every 3 months for 2 years. METHODS AND RESULTS - A cohort of 190 New York Heart Association class III-IV heart failure patients was prospectively enrolled from June 2001 to January 2004. Primary end points were death, cardiac transplantation, or hospitalization. At study enrollment cTnT was <0.01 ng/mL in 87 (45.8%) patients, 0.01 to 0.03 ng/mL in 50 (26.3%) patients, and >0.03 ng/mL in 53 (27.9%) patients. An increase in cTnT above normal (<0.01 ng/mL) carried a 3.4-fold increased risk (P=0.019). Further increases (≥20%) from an elevated level worsened the overall risk (hazard ratio, 5.09; P<0.001). BNP was elevated (>95th percentile for age and gender normal population) in 122 (64.2%) patients. An elevation of BNP from normal at any time during the study was associated with a poor outcome, but, once elevated, further changes in BNP (increases or decreases) remained associated with the same risk (hazard ratio, 5.09; P<0.001). Combined elevations of cTnT (>0.03 ng/mL) and BNP defined the highest risk group (hazard ratio, 8.58; P<0.001). CONCLUSIONS - Elevations of cTnT or BNP from normal detected at any time during clinical follow-up in ambulatory patients with chronic heart failure are highly associated with an increased risk of events. Further increases in cTnT contribute to additional risk. Combined elevations of cTnT and BNP contribute the highest risk. The ability to monitor changes by serial measurements adds substantially to the assessment of risk in this patient population.

Original languageEnglish (US)
Pages (from-to)249-257
Number of pages9
JournalCirculation
Volume116
Issue number3
DOIs
StatePublished - Jul 2007

Fingerprint

Troponin T
Brain Natriuretic Peptide
Heart Failure
Biomarkers
Heart Transplantation
Population
Hospitalization
Odds Ratio

Keywords

  • Heart failure
  • Natriuretic peptides
  • Prognosis
  • Troponin

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Serial biomarker measurements in ambulatory patients with chronic heart failure : The importance of change over time. / Miller, Wayne L.; Hartman, Karen A.; Burritt, Mary F.; Grill, Diane E.; Rodeheffer, Richard J.; Burnett, John C Jr.; Jaffe, Allan S.

In: Circulation, Vol. 116, No. 3, 07.2007, p. 249-257.

Research output: Contribution to journalArticle

Miller, Wayne L. ; Hartman, Karen A. ; Burritt, Mary F. ; Grill, Diane E. ; Rodeheffer, Richard J. ; Burnett, John C Jr. ; Jaffe, Allan S. / Serial biomarker measurements in ambulatory patients with chronic heart failure : The importance of change over time. In: Circulation. 2007 ; Vol. 116, No. 3. pp. 249-257.
@article{a75d1a0f61544b5b8ef176cb0fbf1ed3,
title = "Serial biomarker measurements in ambulatory patients with chronic heart failure: The importance of change over time",
abstract = "BACKGROUND - Cardiac troponin T (cTnT) and B-type natriuretic peptide (BNP) have been used to estimate prognosis in heart failure; however, most studies have evaluated decompensated patients with single measurements. To determine if there are advantages to serial measurements, we evaluated stable chronic heart failure patients every 3 months for 2 years. METHODS AND RESULTS - A cohort of 190 New York Heart Association class III-IV heart failure patients was prospectively enrolled from June 2001 to January 2004. Primary end points were death, cardiac transplantation, or hospitalization. At study enrollment cTnT was <0.01 ng/mL in 87 (45.8{\%}) patients, 0.01 to 0.03 ng/mL in 50 (26.3{\%}) patients, and >0.03 ng/mL in 53 (27.9{\%}) patients. An increase in cTnT above normal (<0.01 ng/mL) carried a 3.4-fold increased risk (P=0.019). Further increases (≥20{\%}) from an elevated level worsened the overall risk (hazard ratio, 5.09; P<0.001). BNP was elevated (>95th percentile for age and gender normal population) in 122 (64.2{\%}) patients. An elevation of BNP from normal at any time during the study was associated with a poor outcome, but, once elevated, further changes in BNP (increases or decreases) remained associated with the same risk (hazard ratio, 5.09; P<0.001). Combined elevations of cTnT (>0.03 ng/mL) and BNP defined the highest risk group (hazard ratio, 8.58; P<0.001). CONCLUSIONS - Elevations of cTnT or BNP from normal detected at any time during clinical follow-up in ambulatory patients with chronic heart failure are highly associated with an increased risk of events. Further increases in cTnT contribute to additional risk. Combined elevations of cTnT and BNP contribute the highest risk. The ability to monitor changes by serial measurements adds substantially to the assessment of risk in this patient population.",
keywords = "Heart failure, Natriuretic peptides, Prognosis, Troponin",
author = "Miller, {Wayne L.} and Hartman, {Karen A.} and Burritt, {Mary F.} and Grill, {Diane E.} and Rodeheffer, {Richard J.} and Burnett, {John C Jr.} and Jaffe, {Allan S}",
year = "2007",
month = "7",
doi = "10.1161/CIRCULATIONAHA.107.694562",
language = "English (US)",
volume = "116",
pages = "249--257",
journal = "Circulation",
issn = "0009-7322",
publisher = "Lippincott Williams and Wilkins",
number = "3",

}

TY - JOUR

T1 - Serial biomarker measurements in ambulatory patients with chronic heart failure

T2 - The importance of change over time

AU - Miller, Wayne L.

AU - Hartman, Karen A.

AU - Burritt, Mary F.

AU - Grill, Diane E.

AU - Rodeheffer, Richard J.

AU - Burnett, John C Jr.

AU - Jaffe, Allan S

PY - 2007/7

Y1 - 2007/7

N2 - BACKGROUND - Cardiac troponin T (cTnT) and B-type natriuretic peptide (BNP) have been used to estimate prognosis in heart failure; however, most studies have evaluated decompensated patients with single measurements. To determine if there are advantages to serial measurements, we evaluated stable chronic heart failure patients every 3 months for 2 years. METHODS AND RESULTS - A cohort of 190 New York Heart Association class III-IV heart failure patients was prospectively enrolled from June 2001 to January 2004. Primary end points were death, cardiac transplantation, or hospitalization. At study enrollment cTnT was <0.01 ng/mL in 87 (45.8%) patients, 0.01 to 0.03 ng/mL in 50 (26.3%) patients, and >0.03 ng/mL in 53 (27.9%) patients. An increase in cTnT above normal (<0.01 ng/mL) carried a 3.4-fold increased risk (P=0.019). Further increases (≥20%) from an elevated level worsened the overall risk (hazard ratio, 5.09; P<0.001). BNP was elevated (>95th percentile for age and gender normal population) in 122 (64.2%) patients. An elevation of BNP from normal at any time during the study was associated with a poor outcome, but, once elevated, further changes in BNP (increases or decreases) remained associated with the same risk (hazard ratio, 5.09; P<0.001). Combined elevations of cTnT (>0.03 ng/mL) and BNP defined the highest risk group (hazard ratio, 8.58; P<0.001). CONCLUSIONS - Elevations of cTnT or BNP from normal detected at any time during clinical follow-up in ambulatory patients with chronic heart failure are highly associated with an increased risk of events. Further increases in cTnT contribute to additional risk. Combined elevations of cTnT and BNP contribute the highest risk. The ability to monitor changes by serial measurements adds substantially to the assessment of risk in this patient population.

AB - BACKGROUND - Cardiac troponin T (cTnT) and B-type natriuretic peptide (BNP) have been used to estimate prognosis in heart failure; however, most studies have evaluated decompensated patients with single measurements. To determine if there are advantages to serial measurements, we evaluated stable chronic heart failure patients every 3 months for 2 years. METHODS AND RESULTS - A cohort of 190 New York Heart Association class III-IV heart failure patients was prospectively enrolled from June 2001 to January 2004. Primary end points were death, cardiac transplantation, or hospitalization. At study enrollment cTnT was <0.01 ng/mL in 87 (45.8%) patients, 0.01 to 0.03 ng/mL in 50 (26.3%) patients, and >0.03 ng/mL in 53 (27.9%) patients. An increase in cTnT above normal (<0.01 ng/mL) carried a 3.4-fold increased risk (P=0.019). Further increases (≥20%) from an elevated level worsened the overall risk (hazard ratio, 5.09; P<0.001). BNP was elevated (>95th percentile for age and gender normal population) in 122 (64.2%) patients. An elevation of BNP from normal at any time during the study was associated with a poor outcome, but, once elevated, further changes in BNP (increases or decreases) remained associated with the same risk (hazard ratio, 5.09; P<0.001). Combined elevations of cTnT (>0.03 ng/mL) and BNP defined the highest risk group (hazard ratio, 8.58; P<0.001). CONCLUSIONS - Elevations of cTnT or BNP from normal detected at any time during clinical follow-up in ambulatory patients with chronic heart failure are highly associated with an increased risk of events. Further increases in cTnT contribute to additional risk. Combined elevations of cTnT and BNP contribute the highest risk. The ability to monitor changes by serial measurements adds substantially to the assessment of risk in this patient population.

KW - Heart failure

KW - Natriuretic peptides

KW - Prognosis

KW - Troponin

UR - http://www.scopus.com/inward/record.url?scp=34547609651&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=34547609651&partnerID=8YFLogxK

U2 - 10.1161/CIRCULATIONAHA.107.694562

DO - 10.1161/CIRCULATIONAHA.107.694562

M3 - Article

C2 - 17592074

AN - SCOPUS:34547609651

VL - 116

SP - 249

EP - 257

JO - Circulation

JF - Circulation

SN - 0009-7322

IS - 3

ER -