Prognostic Value of N-Terminal Pro-B-Type Natriuretic Peptide, Troponin-T, and Growth-Differentiation Factor 15 in Adult Congenital Heart Disease

Baggen, Vivan J.M.; Bosch, Annemien E. van den; Eindhoven, Jannet A.; Schut, Anne-Rose W.; Cuypers, Judith A.A.E.; Witsenburg, Maarten; Waart, Monique de; Schaik, Ron H.N. van; Zijlstra, Felix; Boersma, Eric; Roos‐Hesselink, Jolien W.

doi:10.1161/circulationaha.116.023255

Cited by 99 publications

(107 citation statements)

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“…After complete adjustment for all covariates, the strength of the association was slightly attenuated but remained significant for both the primary end point (adjusted HR per 2‐fold higher value 1.39 [95% CI 1.23–1.57], P <0.001) and the secondary end point (adjusted HR per 2‐fold higher value 1.80 [95% CI 1.42–2.28], P <0.001). The prognostic value of baseline NT‐proBNP in this cohort has been previously published (using standardized HRs) . Of note, baseline eGFR measurements were not predictive of the primary and secondary end point in these multivariable models (adjusted HR per 2‐fold higher value 1.00 [95% CI 0.58–1.72], P =0.993 and 2.49 [95% CI 0.78–7.89], P =0.123, respectively).…”

Section: Resultsmentioning

confidence: 56%

“…Right ventricular systolic pressure was available in 420 patients (71%), of whom 33 patients (7.9%) had pulmonary hypertension. A flowchart of the patient selection and detailed clinical, electrocardiographic and echocardiographic characteristics of the study cohort, also expressed per baseline NT‐proBNP quartile, have been previously reported …”

Section: Resultsmentioning

confidence: 99%

“…The study protocol was approved by the Erasmus MC medical ethics committee and all participants provided written informed consent. Other details of the study protocol have been described previously …”

Section: Methodsmentioning

confidence: 99%

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Prognostic Value of Serial N‐Terminal Pro‐B‐Type Natriuretic Peptide Measurements in Adults With Congenital Heart Disease

Baggen

Baart

Bosch

et al. 2018

JAHA

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BackgroundA single NT‐proBNP (N‐terminal pro‐B‐type natriuretic peptide) measurement is a strong prognostic factor in adult congenital heart disease. This study investigates NT‐proBNP profiles within patients with adult congenital heart disease and relates these to cardiovascular events.Methods and ResultsIn this prospective cohort, 602 patients with adult congenital heart disease were enrolled at the outpatient clinic (years 2011–2013). NT‐proBNP was measured at study inclusion in 595 patients (median age 33 [IQR 25–41] years, 58% male, 90% NYHA I) and at subsequent annual visits. The primary end point was defined as death, heart failure, hospitalization, arrhythmia, thromboembolic event, or cardiac intervention; the secondary end point as death or heart failure. Repeated measurements were analyzed using linear mixed models and joint models. During a median follow‐up of 4.4 [IQR 3.8–4.8] years, a total of 2424 repeated measurements were collected. Average NT‐proBNP increase was 2.9 pmol/L the year before the primary end point (n=199, 34%) and 18.2 pmol/L before the secondary end point (n=58, 10%), compared with 0.3 pmol/L in patients who remained end point‐free (P‐value for difference in slope 0.006 and <0.001, respectively). In patients with elevated baseline NT‐proBNP (>14 pmol/L, n=315, 53%), repeated measurements were associated with the primary end point (HR per 2‐fold higher value 2.08; 95% CI 1.31–3.87; P<0.001) and secondary end point (HR 2.47; 95% CI 1.13–5.70; P=0.017), when adjusted for the baseline measurement.Conclusions NT‐proBNP increased before the occurrence of events, especially in patients who died or developed heart failure. Serial NT‐proBNP measurements could be of additional prognostic value in the annual follow‐up of patients with adult congenitive heart disease with an elevated NT‐proBNP.

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Section: Resultsmentioning

confidence: 56%

Section: Resultsmentioning

confidence: 99%

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Prognostic Value of Serial N‐Terminal Pro‐B‐Type Natriuretic Peptide Measurements in Adults With Congenital Heart Disease

Baggen

Baart

Bosch

et al. 2018

JAHA

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“…In the Framingham Heart Study, patients followed for 11 years who had elevated GDF-15 (median concentration 1066 ng/L ± 594) were found to have increased risk for incident heart failure (HR 1.52, 95% CI 1.29–1.78) [44]. While predictive for incident heart failure in isolation, the added value of GDF-15 to BNP or NT-proBNP is relatively modest [42]. …”

Section: Novel Markers Of Inflammation Fibrosis and Contractilitymentioning

confidence: 99%

Novel Biomarkers of Subclinical Cardiac Dysfunction in the General Population

Shemisa

Bhatt

Cheeran

et al. 2017

Curr Heart Fail Rep

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Purpose of Review Recognition of subclinical myocardial dysfunction offers clinicians and patients an opportunity for early intervention and prevention of symptomatic cardiovascular disease. We review the data on novel biomarkers in subclinical heart disease in the general population with a focus on pathophysiology, recent observational or trial data, and potential applicability and pitfalls for clinical use. Recent Findings High-sensitivity cardiac troponin and natriuretic peptide assays are powerful markers of subclinical cardiac disease. Elevated levels of these biomarkers signify subclinical cardiac injury and hemodynamic stress and portend an adverse prognosis. Novel biomarkers of myocardial inflammation, fibrosis, and abnormal contraction are gaining momentum as predictors for incident heart failure, providing new insight into pathophysiologic mechanisms of cardiac disease. Summary There has been exciting growth in both traditional and novel biomarkers of subclinical cardiac injury in recent years. Many biomarkers have demonstrated associations with relevant cardiovascular outcomes and may enhance the diagnostic and prognostic power of more conventional biomarkers. However, their use in “prime time” to identify patients with or at risk for subclinical cardiac dysfunction in the general population remains an open question. Strategic investigation into their clinical applicability in the context of clinical trials remains an area of ongoing investigation.

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“…Second controversy associated with clinical evidence of advantages of individually adjusted multiple marker approaches in provision of the greatest prognostic improvement among patients with various HF phenotypes [22,23]. Although GDF-15 was useful to detect prevalent of any HF phenotype in addition to NPs, the discriminative value of NPs, GDF-15, sST2, galectin-3 and cardiac troponins in general population was similar [24,25]. Third controversy is follow: In obese and diabetes mellitus subjects GDF-15 was the best predictor for all-cause mortality to NPs, while discriminative value for both markers in combination was not better than single biomarker use [26].…”

Section: Introductionmentioning

confidence: 99%

Growth-Differentiation Factor-15 as Additional Prognostic Biomarkers in Heart Failure

Berezin¹

2017

Metabolomics

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Heart Failure (HF) remains to be a leading factor of cardiovascular morbidity and mortality. Although risk stratification of HF is promising prediction care, there are several controversies regarding choosing more optimal combinations of biomarkers and method (single versus serial measurements) of biomarker use in routine clinical practice. Growth differentiation factor-15 (GDF-15) is considered a biomarker associated with cardiac/vascular remodeling, oxidative stress, fibrosis and inflammation that were proposed to stratify HF patients at risk of death. It has been suggested that GDF-15 adding to natriuretic peptides or other conventional biomarkers (soluble ST2, cardiac troponins and galectin-3) might improve discriminative value of entire predictive models. The short communication is depicted the discussion about the perspectives of clinical use of GDF-15 in risk stratification of HF.

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Prognostic Value of N-Terminal Pro-B-Type Natriuretic Peptide, Troponin-T, and Growth-Differentiation Factor 15 in Adult Congenital Heart Disease

Cited by 99 publications

References 49 publications

Prognostic Value of Serial N‐Terminal Pro‐B‐Type Natriuretic Peptide Measurements in Adults With Congenital Heart Disease

Prognostic Value of Serial N‐Terminal Pro‐B‐Type Natriuretic Peptide Measurements in Adults With Congenital Heart Disease

Novel Biomarkers of Subclinical Cardiac Dysfunction in the General Population

Growth-Differentiation Factor-15 as Additional Prognostic Biomarkers in Heart Failure

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