ECG and Biomarker Profile in Patients with Acute Heart Failure: A Pilot Study

Abstract

Background: Biomarkers, electrocardiogram (ECG) and Holter ECG are basic, accessible and feasible cardiac investigations. The combination of their results may lead to a more complex predictive model that may improve the clinical approach in acute heart failure (AHF). The main objective was to investigate which ECG parameters are correlated with the usual cardiac biomarkers (prohormone N-terminal proBNP, high-sensitive cardiac troponin I) in patients with acute heart failure, in a population from Romania. The relationship between certain ECG parameters and cardiac biomarkers may support future research on their combined prognostic value. Methods: In this prospective case-control study were included 49 patients with acute heart failure and 31 participants in the control group. For all patients we measured levels of prohormone N-terminal proBNP (NT-proBNP), high-sensitive cardiac troponin I (hs-cTnI) and MB isoenzyme of creatine phosphokinase (CK-MB) and evaluated the 12-lead ECG and 24 h Holter monitoring. Complete clinical and paraclinical evaluation was performed. Results: NT-proBNP level was significantly higher in patients with AHF (p < 0.001). In patients with AHF, NT-proBNP correlated with cQTi (p = 0.027), pathological Q wave (p = 0.029), complex premature ventricular contractions (PVCs) (p = 0.034) and ventricular tachycardia (p = 0.048). Hs-cTnI and CK-MB were correlated with ST-segment modification (p = 0.038; p = 0.018) and hs-cTnI alone with complex PVCs (p = 0.031). Conclusions: The statistical relationships found between cardiac biomarkers and ECG patterns support the added value of ECG in the diagnosis of AHF. We emphasize the importance of proper ECG analysis of more subtle parameters that can easily be missed. As a non-invasive technique, ECG can be used in the outpatient setting as a warning signal, announcing the acute decompensation of HF. In addition, the information provided by the ECG complements the biomarker results, supporting the diagnosis of AHF in cases of dyspnea of uncertain etiology. Further studies are needed to confirm long-term prognosis in a multi-marker approach.

Measurement of Cardiac-Specific Biomarkers in the Emergency Department: New Insight in Risk Evaluation

“…Several recent studies and two meta-analyses confirmed the relevance of the measurement of cardiac-specific biomarkers in patients presenting to the ED with acute dyspnea or AHF [81][82][83][84][85][86][87][88][89][90][91][92][93][94][95]. In particular, cardiac NPs have already been included in the initial standard ED diagnostic workup of patients with dyspnea [76].…”

“…According to the most recent clinical studies, high levels of both cardiac-specific biomarkers (i.e., NPs and hs-cTn) in AHF patients are consistently associated with an increased risk of morbidity and mortality, due to the combined presence of a severe reduction in cardiac function and myocardial injury (or even ACS) [56,76,77,80,87,88,[100][101][102]104]. The relevant effect on mortality and MACE in patients admitted to the ED with AHF for several days (or even months), associated with the progressive increase in both specific cardiac biomarkers, has recently been well illustrated in the particular clinical conditions related to COVID-19 infection [105][106][107][108][109][110].…”

Effects of recombinant human brain natriuretic peptide combined with tolvaptan on cardiac and renal function and serum inflammatory factors in patients with severe heart failure

“…In vivo, natriuretic peptides counteract the water and sodium retention caused by angiotensin and endothelin by dilating blood vessels, inhibiting ventricular remodeling, and preventing cardiac decline. [ 18 ] In response to the over-activation of the sympathetic nervous system and RAAS, the “Golden Triangle” of drugs has emerged to improve ventricular remodeling and includes angiotensin-converting enzyme inhibitors or angiotensin receptor antagonists, beta-blockers, and aldosterone receptor antagonists; however, therapeutic effects have been limited. [ 19 ] Further treatment options that can improve cardiac function, reduce circulatory congestion and clinical symptoms, and ensure adequate organ blood supply [ 20 ] are urgently needed to treat recurrent acute episodes of chronic HF and reduce the rates of rehospitalization and mortality and improve overall quality of life.…”

Brain natriuretic peptide in acute heart failure and its association with glomerular filtration rate: A systematic review and meta-analysis

“…[13][14][15][16][17][18] Chetran 2022, Kang 2017, and Kanukurti 2020 achieved the highest score (8, low risk of bias). [19][20][21] None of the studies had a score ≤ 5, indicating a high risk of bias. A funnel plot (Fig.…”