Cardiovascular biomarkers as predictors of adverse outcomes in chronic Chagas cardiomyopathy

Abstract

Background Chronic Chagas Cardiomyopathy (CCM) is a unique form of cardiomyopathy compared to other etiologies of heart failure. In CCM, risk prediction based on biomarkers has not been well-studied. We assessed the prognostic value of a biomarker panel to predict a composite outcome (CO), including the need for heart transplantation, use of left ventricular assist devices, and mortality. Methods Prospective cohort study of 100 adults with different stages of CCM. Serum concentrations of amino-terminal pro-B type natriuretic peptide (NT-proBNP), galectin-3 (Gal-3), neutrophil gelatinase-associated lipocalin (NGAL), high sensitivity troponin T (hs-cTnT), soluble (sST2), and cystatin-C (Cys-c) were measured. Survival analyses were performed using Cox proportional hazard models. Results During a median follow-up of 52 months, the mortality rate was 20%, while the CO was observed in 25% of the patients. Four biomarkers (NT-proBNP, hs-cTnT, sST2, and Cys-C) were associated with the CO; concentrations of NT-proBNP and hs-cTnT were associated with the highest AUC (85.1 and 85.8, respectively). Combining these two biomarkers above their selected cut-off values significantly increased risk for the CO (HR 3.18; 95%CI 1.31–7.79). No events were reported in the patients in whom the two biomarkers were under the cut-off values, and when both levels were above cut-off values, the CO was observed in 60.71%. Conclusion The combination of NT-proBNP and hs-TnT above their selected cut-off values is associated with a 3-fold increase in the risk of the composite outcome among CCM patients. The use of cardiac biomarkers may improve prognostic evaluation of patients with CCM.

Assessment of biomarkers and clinical parameters as predictors of survival in patients with chagasic heart failure

“…However, it is important to note that most studies have been conducted in patients with HF of any etiology [ 13 – 15 ]. In the Chagasic population, the association between elevated natriuretic peptide and high-sensitivity TnT with worse prognosis has been corroborated in some studies [ 16 , 17 ]. However, there have been conflicting results, with one study not confirming this relationship when using a non-highly sensitive TnT assay [ 18 , 19 ].…”

Chagas Heart Disease: Beyond a Single Complication, from Asymptomatic Disease to Heart Failure

“…Some markers are galectin-3 (Gal-3), neutrophil gelatinase-associated lipocalin (NGAL), soluble ST2 protein (sST2), cystatin-C (Cys-c), an amino-terminal fragment of brain natriuretic peptide (NT-proBNP), and high-sensitivity troponin T (hs-cTnT). All biomarkers except NGAL and Gal-3 have been associated with cardiac transplantation, use of left ventricular assist devices, and death, and the combination of NT-proBNP and hs-cTnT or sST2 is associated with an increased risk of death in patients with CCC [109,110].…”

Blood DNA methylation marks discriminate Chagas cardiomyopathy disease clinical forms

“…For CCC especially, an ECG and/or an echocardiogram is made to confirm cardiac involvement ( 13 ). BNP and NT-proBNP, well-known markers be associated with cardiac dysfunction ( 14 ), have been associated to Chagas cardiomyopathy ( 15 , 16 ), but are not specific to this pathology. Others markers, including miRNAs ( 17 , 18 ), cytokines ( 19 ) or metalloproteinases ( 20 ) have been proposed as biomarkers for CCC, but no confirmation has been made in a test cohort at this time.…”