Echocardiographic assessment of insulin‐like growth factor binding protein‐7 and early identification of acute heart failure

Abstract

Aims Concentrations of insulin-like growth factor binding protein-7 (IGFBP7) have been linked to abnormal cardiac structure and function in patients with chronic heart failure (HF), but cardiovascular correlates of the biomarker in patients with more acute presentations are lacking. We aimed to determine the relationship between IGFBP7 concentrations and cardiac structure and to evaluate the impact of IGFBP7 on the diagnosis of acute HF among patients with acute dyspnoea. Methods and results In this pre-specified subgroup analysis of the International Collaborative of N-terminal pro-B-type Natriuretic Peptide Re-evaluation of Acute Diagnostic CutOffs in the Emergency Department (ICON-RELOADED) study, we included 271 patients with and without acute HF. All patients presented to an emergency department with acute dyspnoea, had blood samples for IGFBP7 measurement, and detailed echocardiographic evaluation. Higher IGFBP7 concentrations were associated with numerous cardiac abnormalities, including increased left atrial volume index (LAVi; r = 0.49, P < 0.001), lower left ventricular ejection fraction (r = À0.27, P < 0.001), lower right ventricular fractional area change (r = À0.31, P < 0.001), and higher tissue Doppler E/e′ ratio (r = 0.44, P < 0.001). In multivariable linear regression analyses, increased LAVi (P = 0.01), lower estimated glomerular filtration rate (P = 0.008), higher body mass index (P = 0.001), diabetes (P = 0.009), and higher concentrations of amino-terminal pro-B-type natriuretic peptide (NT-proBNP, P = 0.02) were independently associated with higher IGFBP7 concentrations regardless of other variables. Furthermore, IGFBP7 (odds ratio = 12.08, 95% confidence interval 2.42-60.15, P = 0.02) was found to be independently associated with the diagnosis of acute HF in the multivariable logistic regression analysis. Conclusions Among acute dyspnoeic patients with and without acute HF, increased IGFBP7 concentrations are associated with a range of cardiac structure and function abnormalities. Independent association with increased LAVi suggests elevated left ventricular filling pressure is an important trigger for IGFBP7 expression and release. IGFBP7 may enhance the diagnosis of acute HF.

IGFBP7 Concentration May Reflect Subclinical Myocardial Damage and Kidney Function in Patients with Stable Ischemic Heart Disease

“…In our study there was a significant correlation between IGFBP7 and NTproBNP concentration in patients with IHD. According to previous findings, it seems that left ventricular filling pressure may be an important trigger for IGFBP7 expression and release because of its strong independent association with an increased left atrial volume index (LAVI) [ 25 , 26 ]. We have not assessed ejection fraction (EF) in our research, but our previous findings showed no statistically significant differences of IGFBP7 concentrations between low-EF (<50%) and high-EF (>50%) patients [ 11 ].…”

Insulin‐like growth factor binding protein 7 (IGFBP7), a link between heart failure and senescence

“…10,11 One study reported IGFBP7 as a possible biomarker of acute HF, improving the diagnosis in patients presenting with acute dyspnoea. 12,13 Gandhi et al reported that low IGFBP7 levels were predictive of event-free survival in patients with reduced ejection fraction. 14 Furthermore, IGFBP7 also presented as a potential marker of HF with preserved ejection fraction (HFpEF).…”

“…IGFBP7 was first found to be up‐regulated in mouse HF models and in patients with HF and cardiac hypertrophy 10,11 . One study reported IGFBP7 as a possible biomarker of acute HF, improving the diagnosis in patients presenting with acute dyspnoea 12,13 . Gandhi et al reported that low IGFBP7 levels were predictive of event‐free survival in patients with reduced ejection fraction 14 .…”

Cardiac remodelling – Part 1: From cells and tissues to circulating biomarkers. A review from the Study Group on Biomarkers of the Heart Failure Association of the European Society of Cardiology

“…96 Pro-inflammatory cytokines also trigger the release of other factors such as insulin-like growth factor binding protein-7 (IGFBP-7). Elevated serum levels of IGFBP-7 are associated with left atrial remodelling and diastolic dysfunction in patients with acute dyspnoea (with or without HF) 97 and in HFpEF patients, 98 as well as with a higher risk of cardiovascular events including mortality. 98 The pro-inflammatory alarmins S100A8 and S100A9 play a role in cardiac remodelling after MI.…”