Conventional Biomarkers for Predicting Clinical Outcomes in Patients with Heart Disease
Abstract
:1. Introduction
2. Materials and Methods
3. Results
3.1. Natriuretic Peptides (NPs)
3.1.1. Predictors of NPs Levels
3.1.2. NPs in the Absence of CVD
3.1.3. NPs Prior to ACS
3.1.4. NPs in ACS
3.1.5. NPs after ACS
3.1.6. NPs in HF
3.1.7. NPs Improve Current Predictive Models
3.2. Cardiac Troponins (cTns)
3.2.1. High-Sensitivity Cardiac Troponin I (hs-cTnI)
3.2.2. Determinants of High-Sensitivity Cardiac Troponin I
3.2.3. High-Sensitivity Cardiac Troponin T
3.2.4. Troponins as Biomarkers for Incident or Subclinical HF
3.2.5. Post-Hospitalization or Post-Procedural Troponin Elevations
3.2.6. Point-of-Care Troponin Assays
3.2.7. Prediction Scores Including Cardiac Troponins
3.3. Parameters of the Lipid Metabolism
3.3.1. Cholesterol and Triglycerides
3.3.2. Lipoprotein (a)
3.3.3. Other Lipid-Related Parameters
3.4. Inflammatory Markers
3.4.1. High Sensitivity CRP (hs-CRP)
Biomarker | Participants | N | Primary Outcome | Median Follow-Up | Cut-Off Value | HR/OR [95% CI] | Ref. |
---|---|---|---|---|---|---|---|
hs-CRP | MI survivors | 17,464 | MACE:nonfatal MI, nonfatal ischemic stroke or CV death | 3.2 years | Baseline ≥2 mg/L | HR 1.28 [1.18–1.38] | [45] |
Post-STEMI patients | 204 | LVSD at 6 months after hospital discharge | 5.6 years | ≥19.67 mg/L at 24 h after admission | OR 1.47 [1.10–1.97] | [46] | |
CRP | Previous MI patients | 2184 | All-cause mortality | 6.4 years | Baseline ≥2 mg/L and ≥2 mg/L at 1 year | HR 2.12 [1.60–2.80] | [47] |
CV mortality | HR 2.31 [1.48–3.61] |
3.4.2. Kinetic Evaluation of CRP and hs-CRP
4. Discussion
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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NP | Trial | Participants | Outcome(s) | Follow-Up | N | Predictor/ Cut-Off Value | Risk [95% CI] | Ref. |
---|---|---|---|---|---|---|---|---|
BNP | LIPID | Stable CHD (ACS history) | HHF or HF death | 5 years | 1729 | Increased >50.29 pg/mL | HR 2.04 [1.70–2.46] | [15] |
Hellenic HF Study | ACS diagnosis | Fatal CV event | 10 years | 1000 | Two-fold increase | OR 1.34 [1.10–1.63] | [20] | |
EPHESUS | MI + LVSD or DM + MI + LVSD | All-cause death (BNP baseline and 1-month change) | 12.6 months | 463 | Tertile 3 vs. tertile 1 (baseline: >128 vs. <199 pg/mL; 1-month change: >11 vs. −93 pg/mL) | OR 10.90 [2.40–49.5] OR 1.72 [0.81–3.69] | [14] | |
CV death or HHF (BNP baseline and 1-month change) | OR 10.10 [3.41–30.2] OR 2.28 [1.21–4.28] | |||||||
ELIXA | DM with recent ACS | HF | 26 months | 5525 | >500 pg/mL | HR 3.00 [2.10–4.10] | [18] | |
NT-proBNP | >700 pg/mL | HR 2.50 [1.70–3.50] | ||||||
(log2)NT-proBNP | EXAMINE | DM with recent ACS | Composite HF outcome: CV death, HHF, initiation of loop diuretics, or elevated NT-proBNP at follow-up | 18 months | 5154 | Higher | HR 1.24 [1.18–1.31] | [17] |
CV death or HHF | Two-fold increase | HR 1.45 [1.34–1.57] | ||||||
(ln)NT-proBNP | CAD with recent ACS | All-cause death | 52 months | 642 | Higher | HR 1.53 [1.13–2.07] | [16] | |
Cardiac-related death | Higher | HR 1.62 [1.11–2.36] | ||||||
Lower survival | ≥290.4 pg/mL | HR 3.79 [1.57–9.15] | ||||||
5-year ΔNT-proBNP | Heart and Soul Study | Stable CAD | Composite: HF or CV death | 4 years (total: 9) | 635 | Quartile 4 vs. quartile 1 (>222 vs. ≤5 pg/mL) | HR 3.90 [1.10–13.40] | [19] |
Tn | Trial | Participants | N | Outcome (s) | Median Follow-Up | Cut-Off Value | HR [95% CI] | Ref. |
---|---|---|---|---|---|---|---|---|
hs-cTnI | Busselton Health Study cohort | Population-based cohort | 3939 | CVD mortality | 20 years | Per doubling of baseline level | 1.33 [1.23–1.44] | [25] |
Total mortality | 1.16 [1.09–1.24] | |||||||
CVD events | 1.18 [1.11–1.25] | |||||||
HF | 1.44 [1.31–1.58] | |||||||
Suspected ACS | 4748 | HHF | 156 days | Per doubling of baseline level when <URL (women 16 ng/L, men 34 ng/L) | 2.80 [1.81–4.31] | [26] | ||
Jackson Heart Study | No baseline CVD | 3987 | Incident HF | 9.8 years | 4–10 ng/L (women), 6–12 ng/L (men) | 1.92 [1.41–1.60] | [29] | |
>10 ng/L (women), >12 ng/L (men) | 3.52 [2.54–4.87] | |||||||
ARIC Study | No baseline CVD | 8121 | Incident CHD | 15 years | ≥3.8 ng/L | 2.20 [1.64–2.95] | [31] | |
HHF | 4.20 [3.28–5.37] | |||||||
Global CVD | 3.01 [2.50–3.63] | |||||||
All-cause mortality | 1.83 [1.56–2.14] | |||||||
hs-cTnT | No baseline HF or CHD | 8838 | HF | 14 years | baseline <0.005 ng/mL and follow-up >0.005 ng/mL | 2 [1.60–2.40] | [30] | |
CHD | 1.4 [1.20–1.60] | |||||||
Mortality | 1.5 [1.30–1.70] | |||||||
Incident MI | 1054 | All-cause mortality, CV mortality, recurrent MI, HF, or stroke | 3 years | ≥14 ng/L | 1.53 [1.20–1.94] | [6] | ||
9–13 ng/L | 1.27 [1.00–1.61] | |||||||
TnI | ASTRO-NAUT | Stable patients hospitalized for HF | 1469 | All-cause mortality | 12 months | >0.04 ng/mL at 1 month follow-up | 1.59 [1.18–2.13] | [32] |
CV mortality or HHF | 1.28 [1.03–1.58] | |||||||
TnT | MESA | No baseline CVD | 6781 | New onset HFpEF | 11.2 years | >0.01 ng/mL | 4.5 [1.90–10.90] | [5] |
Biomarker | Details | Outcome(s) | Follow-Up | N | Predictor/Cut-Off Value | Risk [95% CI] | Ref. |
---|---|---|---|---|---|---|---|
LDL-C | Stable CHD (ACS history) | HHF or HF death | 5 years | 6909 | >2.5 mmol/L (>97 mg/dL) | HR 2.26 [1.07–4.76] | [15] |
First STEMI + PCI | MVI | 48 h | 235 | Higher | OR 1.02 [1.01–1.02] | [36] | |
MACE: all-cause death, MI, or CHF | 20 months | 222 | >3.88 mmol/L (>150 mg/dL) | HR 3.09 [1.22–7.87] | |||
LDL-C variability | STEMI survivors | MACE: all-cause death, non-fatal MI/stroke, HHF, or unplanned revascularization | 62.4 months | 130 | Per 0.01 cVIM increase | HR 1.03 [1.00–1.06] | [39] |
HDL-C variability | HR 1.06 [1.00–1.13] | ||||||
Non-HDL-C | Chronic HF with a history of MI; treated with statins | Recurrent MI | 8.6 years | 1842 | ≥3.36 mmol/L (≥130 mg/dL) vs. <2.58 mmol/L (<100 mg/dL) | HR 2.70 [1.17–6.24] | [38] |
Lp(a) | ARIC Study (Community study) | HHF | 23.4 years | 14,154 | Quintiles 4 (11.43–22.96 mg/dL) and 5 (23.10–108.23 mg/dL) vs. quintile 1 (0.02–2.41 mg/dL) | HR 1.16 [1.02–1.34] and HR 1.21 [1.06–1.38] | [41] |
Stable CHD (ACS history) | HHF or HF death | 5 years | 7101 | Not predictive | HR not published (p = 0.34) | [15] | |
ACS + CAG | MACE: cardiac death, MI, or stroke | 1 year | 1711 | Not predictive (≥30 mg/dL, tertile 3 vs. tertile 1, and per 1 SD increase) | HR 1.05 [0.64–1.73], HR 0.82 [0.52–1.28], and HR 0.98 [0.82–1.19] | [42] * | |
TyG index | MINOCA | MACE: all-cause death, stroke, reinfarction, revascularization, UA, or HHF | 41.7 months | 1179 | Higher; tertiles 2 and 3 vs. tertile 1 | HR 1.33 [1.04–1.69]; HR 1.64 [1.06–2.53] and HR 1.85 [1.17–2.93] | [40] |
7-KC | Stable CAD (± previous MI) | MI | 4.6 years | 1016 | Quartile 4 vs. quartile 1 (>109.8 vs. <55.8 nmol/L) | HR 1.62 [1.35–1.98] | [44] |
HHF | HR 1.43 [1.22–1.76] | ||||||
CV death | HR 1.79 [1.46–2.18] | ||||||
All-cause death | HR 1.91 [1.58–2.39] | ||||||
MI, HHF, or death | HR 1.76 [1.42–2.21] | ||||||
(log)vaspin | STEMI and NSTEMI patients | MACE: CV death, recurrent MI, or HHF | 1036 | Lower | HR 0.74 [0.48–0.96] | [43] | |
HHF | HR 0.58 [0.37–0.89] | ||||||
Recurrent MI | HR 0.72 [0.53–0.95] |
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Mănescu, I.-B.; Pál, K.; Lupu, S.; Dobreanu, M. Conventional Biomarkers for Predicting Clinical Outcomes in Patients with Heart Disease. Life 2022, 12, 2112. https://doi.org/10.3390/life12122112
Mănescu I-B, Pál K, Lupu S, Dobreanu M. Conventional Biomarkers for Predicting Clinical Outcomes in Patients with Heart Disease. Life. 2022; 12(12):2112. https://doi.org/10.3390/life12122112
Chicago/Turabian StyleMănescu, Ion-Bogdan, Krisztina Pál, Silvia Lupu, and Minodora Dobreanu. 2022. "Conventional Biomarkers for Predicting Clinical Outcomes in Patients with Heart Disease" Life 12, no. 12: 2112. https://doi.org/10.3390/life12122112