Document Detail


Multimarker strategy for the prediction of 31 days cardiac death in patients with acutely decompensated chronic heart failure.
MedLine Citation:
PMID:  19157603     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: To investigate the combined prognostic value of admission serum levels of B-type natriuretic peptide (BNP), cardiac troponin I (cTnI) and high sensitivity C-reactive protein (hs-CRP), in patients hospitalized because of acutely decompensated severe (New York Heart Association class III/IV) low-output chronic heart failure (CHF). METHODS: A total of 577 consecutive patients recruited in the 5 participating centers, were studied. Cardiac mortality by 31 days was the prespecified primary study end point. RESULTS: A total of 102 (17.7%) patients died by 31 days. When the study patients were divided according to the number of elevated study biomarkers, there was a significant gradual increased risk of 31-day cardiac death with increasing in the number of elevated biomarkers (p<0.001). The value of the discriminant C statistic for the Cox regression analysis, increased significantly when each of the study biomarkers was incorporated with the other risk predictors into a Cox regression model, with the highest C statistic value for the Cox regression model that included all the study biomarkers (p<0.001). By multivariate Cox regression analysis, elevated serum levels of BNP (p=0.002), cTnI (p<0.001) and hs-CRP (p=0.02) were independent predictors of the study end point. CONCLUSIONS: In conclusion, in patients hospitalized for acute decompensation of severe (NYHA III/IV) low-output CHF, BNP, cTnI and hs-CRP upon admission offers enhanced early risk stratification. With increasing number of elevated biomarkers, the risk of 31-day cardiac death increases gradually that implies treatment intensification, and closer follow-up.
Authors:
Michael N Zairis; George Z Tsiaousis; Anastassios Theodossis Georgilas; Stamatis S Makrygiannis; Evdokia N Adamopoulou; Stelios M Handanis; Pelagia C Batika; Athanasios A Prekates; Dimitris Velissaris; Nikolaos T Kouris; Demetrios Z Mytas; Demetrios K Babalis; Kostas S Karidis; Stefanos G Foussas
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Publication Detail:
Type:  Journal Article     Date:  2009-01-20
Journal Detail:
Title:  International journal of cardiology     Volume:  141     ISSN:  1874-1754     ISO Abbreviation:  Int. J. Cardiol.     Publication Date:  2010 Jun 
Date Detail:
Created Date:  2010-05-31     Completed Date:  2010-09-16     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8200291     Medline TA:  Int J Cardiol     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  284-90     Citation Subset:  IM    
Copyright Information:
Copyright (c) 2008 Elsevier Ireland Ltd. All rights reserved.
Affiliation:
Department of Cardiology, Tzanio Hospital, Piraeus, Greece. zairis66@otenet.gr
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MeSH Terms
Descriptor/Qualifier:
Acute Disease
Aged
Aged, 80 and over
Biological Markers / blood*
C-Reactive Protein / metabolism
Cardiac Output
Chronic Disease
Death, Sudden, Cardiac / epidemiology*
Female
Follow-Up Studies
Heart Failure* / blood,  diagnosis,  mortality
Humans
Male
Multivariate Analysis
Natriuretic Peptide, Brain / blood
Predictive Value of Tests
Prognosis
Proportional Hazards Models
ROC Curve
Risk Factors
Severity of Illness Index
Troponin I / blood
Chemical
Reg. No./Substance:
0/Biological Markers; 0/Troponin I; 114471-18-0/Natriuretic Peptide, Brain; 9007-41-4/C-Reactive Protein

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