Prognostic importance of emerging cardiac, inflammatory, and renal biomarkers in chronic heart failure patients with reduced ejection fraction and anaemia: RED-HF study

Welsh, P. et al. (2018) Prognostic importance of emerging cardiac, inflammatory, and renal biomarkers in chronic heart failure patients with reduced ejection fraction and anaemia: RED-HF study. European Journal of Heart Failure, 20(2), pp. 268-277. (doi: 10.1002/ejhf.988) (PMID:28960777) (PMCID:PMC6607475)

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Aims: To test the prognostic value of emerging biomarkers in the Reduction of Events by Darbepoetin Alfa in Heart Failure (RED-HF) trial. Methods and results: Circulating cardiac [N-terminal pro-B-type natriuretic peptide (NT-proBNP), and high-sensitivity troponin T (hsTnT)], neurohumoral [mid-regional pro-adrenomedullin (MR-proADM) and copeptin], renal (cystatin C), and inflammatory [high-sensitivity C-reactive protein (hsCRP)] biomarkers were measured at randomization in 1853 participants with complete data. The relationship between these biomarkers and the primary composite endpoint of heart failure hospitalization or cardiovascular death over 28 months of follow-up (n = 834) was evaluated using Cox proportional hazards regression, the c-statistic and the net reclassification index (NRI). After adjustment, the hazard ratio (HR) for the composite outcome in the top tertile of the distribution compared to the lowest tertile for each biomarker was: NT-proBNP 3.96 (95% CI 3.16–4.98), hsTnT 3.09 (95% CI 2.47–3.88), MR-proADM 2.28 (95% CI 1.83–2.84), copeptin 1.66 (95% CI 1.35–2.04), cystatin C 1.92 (95% CI 1.55–2.37), and hsCRP 1.51 (95% CI 1.27–1.80). A basic clinical prediction model was improved on addition of each biomarker individually, most strongly by NT-proBNP (NRI +62.3%, P < 0.001), but thereafter was only improved marginally by addition of hsTnT (NRI +33.1%, P = 0.004). Further addition of biomarkers did not improve discrimination further. Findings were similar for all-cause mortality. Conclusion: Once NT-proBNP is included, only hsTnT moderately further improved risk stratification in this group of chronic heart failure with reduced ejection fraction patients with moderate anaemia. NT-proBNP and hsTnT far outperform other emerging biomarkers in prediction of adverse outcome.

Item Type:Articles
Glasgow Author(s) Enlighten ID:Welsh, Dr Paul and McMurray, Professor John and Sattar, Professor Naveed
Authors: Welsh, P., Kou, L., Yu, C., Anand, I., van Veldhuisen, D. J., Maggioni, A. P., Desai, A. S., Solomon, S. D., Pfeffer, M. A., Cheng, S., Gullestad, L., Aukrust, P., Ueland, T., Swedberg, K., Young, J. B., Kattan, M. W., Sattar, N., and McMurray, J. J.V.
College/School:College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
Journal Name:European Journal of Heart Failure
ISSN (Online):1879-0844
Published Online:27 September 2017
Copyright Holders:Copyright © 2017 The Authors
First Published:First published in European Journal of Heart Failure 20(2):268-277
Publisher Policy:Reproduced under a Creative Commons License

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
612031Cardiac biomarkers and CVD risk screening: a cost-effective public health measure?Paul WelshBritish Heart Foundation (BHF)FS/12/62/29889RI CARDIOVASCULAR & MEDICAL SCIENCES