Abstract 212: Integration of Multiple Cardiac Biomarkers into a Disease-Specific Score: Relationship to Clinical Status and Therapeutic Intensity

Abstract

Introduction: The 2013 American College of Cardiology/American Heart Association postulated four blood biomarkers as key parameters in the risk-stratification and management of heart failure (HF). These four markers, troponin I or T, B-type natriuretic peptide or N-terminal BNP, galectin-3, and ST2, each reflect different aspects of myocardial pathophysiology in HF. We propose a novel method of integration of biomarkers which are summarized into a Modified Myocardial Injury Summary Score (MMISS) to serve as an individualized biomarker-based index of HF severity. Methods: For each patient, biomarkers were used to calculate the MMISS (Σ log10 [Biomarker(i)measured / Biomarker(i)ULN]/n, i=1). Pharmacologic regimen recorded at the time of biomarker draw was assimilated into a Therapeutic Intensity Index (TTI) based upon dosing of pertinent HF drug classes. A univariate analysis was performed to determine the relationship between MMISS and TII among patients included in this cross sectional study. Results: Of the 39 patients included in the study, 61.9% were male with a mean age of 60.5 ± 10.5. A total of 13(33.3%), 22(56.4%), and 4(10.3%) patients were classified as NYHA FC 2, 3, and 4, respectively. The etiology of HF was ischemic cardiomyopathy in 51% of patients. In creating the MMISS, 24(61.5%), 2(5.1%), and 13(33.3%) patients had two, three, and four biomarkers available, respectively. Through our analysis, we found the MMISS (range -0.76 to +1.08) to have no association with TII (R= -0.23, p=0.15). Conclusions: There is no significant correlation between the intensity of medical management and myocardial disease severity as reflected by cardiac biomarkers measured at a single time in cross-section. Our findings suggest there may be an opportunity to tailor therapy to the severity of disease as indicated by blood biomarkers. We plan to use our observation as basis for a randomized trial that leverages measured changes in MMISS to guide personalization of medical therapy.