Neurohormonal Activation in Acute Heart Failure: Results from VERITAS

Milo-Cotter, Olga; Davison, Beth A.; Lombardi, Carlo; Sun, Han; Bettari, Luca; Bugatti, Silvia; Rund, Michele M.; Metra, Marco; Kaluski, Edo; Kobrin, Isaac; Frey, Aline; Rainisio, Maurizio; McMurray, John J.V.; Teerlink, John R.; Cotter-Davison, Gad

doi:10.1159/000330409

Cited by 59 publications

(46 citation statements)

References 62 publications

(46 reference statements)

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“…191 This could potentially be useful for selecting high-risk patients not previously identified with traditional risk factors. CRP and other inflammatory markers, 192,193 endothelin, 194 MR-proADM, 195 and copeptin 196,197 have also been shown to be independently associated with clinical outcome after AHF in some data sets. In general, studies analyzing the additive value of multiple markers typically find newer markers to be modestly complementary to standard risk factors and natriuretic peptide levels.…”

Section: P<0001)mentioning

confidence: 98%

Role of Biomarkers for the Prevention, Assessment, and Management of Heart Failure: A Scientific Statement From the American Heart Association

Chow¹,

Maisel²,

et al. 2017

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Background and Purpose: Natriuretic peptides have led the way as a diagnostic and prognostic tool for the diagnosis and management of heart failure (HF). More recent evidence suggests that natriuretic peptides along with the next generation of biomarkers may provide added value to medical management, which could potentially lower risk of mortality and readmissions. The purpose of this scientific statement is to summarize the existing literature and to provide guidance for the utility of currently available biomarkers. Methods: The writing group used systematic literature reviews, published translational and clinical studies, clinical practice guidelines, and expert opinion/statements to summarize existing evidence and to identify areas of inadequacy requiring future research. The panel reviewed the most relevant adult medical literature excluding routine laboratory tests using MEDLINE, EMBASE, and Web of Science through December 2016. The document is organized and classified according to the American Heart Association to provide specific suggestions, considerations, or contemporary clinical practice recommendations. Results: A number of biomarkers associated with HF are well recognized, and measuring their concentrations in circulation can be a convenient and noninvasive approach to provide important information about disease severity and helps in the detection, diagnosis, prognosis, and management of HF. These include natriuretic peptides, soluble suppressor of tumorgenicity 2, highly sensitive troponin, galectin-3, midregional proadrenomedullin, cystatin-C, interleukin-6, procalcitonin, and others. There is a need to further evaluate existing and novel markers for guiding therapy and to summarize their data in a standardized format to improve communication among researchers and practitioners. Conclusions: HF is a complex syndrome involving diverse pathways and pathological processes that can manifest in circulation as biomarkers. A number of such biomarkers are now clinically available, and monitoring their concentrations in blood not only can provide the clinician information about the diagnosis and severity of HF but also can improve prognostication and treatment strategies.

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Section: P<0001)mentioning

confidence: 98%

Role of Biomarkers for the Prevention, Assessment, and Management of Heart Failure: A Scientific Statement From the American Heart Association

Chow¹,

Maisel²,

et al. 2017

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“…RELAX included S‐HFpEF patients while DOSE and ROSE included acutely decompensated HF (ADHF) patients with both HFrEF and HFpEF. IL‐6, TNF‐α, and hs‐CRP were selected because of the long‐standing experience with their use in HF10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20 and PTX3 because of its association with vascular inflammation21 and ability to risk‐stratify HF patients. Each trial was approved by the Institutional Review Board at each participating site, and all patients provided written informed consent.…”

Section: Methodsmentioning

confidence: 99%

Pro‐Inflammatory Biomarkers in Stable Versus Acutely Decompensated Heart Failure With Preserved Ejection Fraction

Abernethy

Raza

Sun

et al. 2018

JAHA

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BackgroundUnderlying inflammation has been increasingly recognized in heart failure with a preserved ejection fraction (HFpEF). In this study we tested the hypothesis that pro‐inflammatory biomarkers are elevated in patients with acutely decompensated HFpEF (AD‐HFpEF) compared with patients with stable HFpEF (S‐HFpEF).Methods and ResultsUsing a post hoc analysis the serum biomarkers tumor necrosis factor‐alpha, high‐sensitivity C‐reactive protein interleukin 6 and pentraxin 3 (PTX3) and clinical, demographic, echocardiographic‐Doppler and clinical outcomes data were analyzed in HFpEF patients enrolled in NHLBI Heart Failure Research Network clinical trials which enrolled patients with either AD‐HFpEF or S‐HFpEF. Compared to S‐HFpEF, AD‐HFpEF patients had higher levels of PTX3 (3.08 ng/mL versus 1.27 ng/mL, P<0.0001), interleukin‐6 (4.14 pg/mL versus 1.71 pg/mL, P<0.0001), tumor necrosis factor‐alpha (11.54 pg/mL versus 8.62 pg/mL, P=0.0015), and high‐sensitivity C‐reactive protein (11.90 mg/dL versus 3.42 mg/dL, P<0.0001). Moreover, high‐sensitivity C‐reactive protein, interleukin‐6 and PTX3 levels were significantly higher in AD‐HFpEF compared with S‐HFpEF patients admitted for decompensated HF within the previous year. PTX3 was positively correlated with left atrial volume index (r=0.41, P=0.0017) and left ventricular mass (r=0.26, P=0.0415), while tumor necrosis factor‐alpha was inversely correlated with E/A ratio (r=−0.31, P=0.0395).ConclusionsLevels of pro‐inflammatory biomarkers are strikingly higher in AD‐HFpEF compared with S‐HFpEF patients. PTX3 and tumor necrosis factor‐alpha are correlated with echocardiographic‐Doppler evidence of diastolic dysfunction. Taken together these data support the concept that a heightened pro‐inflammatory state has a pathophysiologic role in the development of AD‐HFpEF.

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“…Medical history was taken and routine clinical laboratory measures assayed locally at baseline. Plasma samples were obtained immediately prior to study drug initiation (baseline) and stored at -20 o C locally and shipped to a core laboratory for analysis (BioProof AG, Munich, Germany) (12). BNP and troponin I were measured using commercially-available ELISA kits: Peninsula Laboratories, San Carlos, USA for BNP and Labmaster, Turku, Finland for troponin I.…”

Section: Methodsmentioning

confidence: 99%

Predictors and Associations With Outcomes of Length of Hospital Stay in Patients With Acute Heart Failure: Results From VERITAS

Cotter

Davison

Milo

et al. 2016

Journal of Cardiac Failure

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Background: The length of hospital stay (LOS) is important in patients admitted for acute heart failure (AHF) as it prolongs an unpleasant experience for the patients and adds substantially to health care costs. Methods and Results: We examined the association between LOS and baseline characteristics, 10-day post-discharge HF readmission, and 90-day postdischarge mortality in 1,347 patients with AHF enrolled in the VERITAS program. Longer LOS was associated with greater HF severity and disease burden at baseline; however, most of the variability of LOS could not be explained by these factors. LOS was not associated with readmissions during the first days after discharge. However, LOS was a significant predictor of 90-day mortality (Hazard ratio for 1 day increase: 1.05; 95% C.I. 1.02, 1.07, p=0.00004), although the association is partially explained by concurrent end organ damage and worsening heart failure (WHF) during the first days of admission. Conclusions: In patients who have been admitted for Acute HF; longer length of hospital stay is associated with a higher rate of short-term mortality. Clinical Trial Registration: VERITAS-1 and -2:Clinicaltrials.gov identifiers NCT00525707 and NCT00524433. https://clinicaltrials.gov/ct2/results?term=NCT00525707&Search=Search

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Neurohormonal Activation in Acute Heart Failure: Results from VERITAS

Cited by 59 publications

References 62 publications

Role of Biomarkers for the Prevention, Assessment, and Management of Heart Failure: A Scientific Statement From the American Heart Association

Role of Biomarkers for the Prevention, Assessment, and Management of Heart Failure: A Scientific Statement From the American Heart Association

Pro‐Inflammatory Biomarkers in Stable Versus Acutely Decompensated Heart Failure With Preserved Ejection Fraction

Predictors and Associations With Outcomes of Length of Hospital Stay in Patients With Acute Heart Failure: Results From VERITAS

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