Measurement of multiple biomarkers in advanced stage heart failure patients treated with pulmonary artery catheter guided therapy.
Crit Care. 2012 Jul 25;16(4):R135
Authors: Zilinski JL, Shah RV, Gaggin HK, Gantzer ML, Wang TJ, Januzzi JL
ABSTRACT: INTRODUCTION: To investigate prognostic utility of biomarkers in advanced stage heart failure (HF) patients requiring intensive care unit (ICU) admission for pulmonary artery catheter (PAC) guided therapy. METHODS: 30 patients admitted to an ICU for PAC guided HF therapy were enrolled; concentrations of soluble ST2 (sST2), highly sensitive troponin I, an experimental ultrasensitive troponin I, amino-terminal pro-B type natriuretic peptide, cystatin C, and myeloperoxidase were measured over the first 48 hours. Outcomes included response of filling pressures and hemodynamics to tailored therapy and 90-day event-free survival (death, left ventricular assist device implantation, transplant). RESULTS: Of the biomarkers evaluated, only sST2 concentrations were higher in those who failed to achieve goals for central venous pressure ([CVP], 225.3 vs 104.6 ng/mL; p=0.003) and pulmonary capillary wedge pressure ([PCWP], 181.7 vs 88.2 ng/mL; p=0.05). Only sST2 concentrations were associated with adverse events (186.7 vs 92.2 ng/mL; p=0.01). In age-adjusted Cox proportional hazards analysis, an elevated sST2 during the first 48 hours following ICU admission independently predicted 90-day outcomes (Hazard Ratio=5.53; p=0.03) superior to the Simplified Acute Physiology Score for this application; in Kaplan-Meier analysis the risk associated with elevated sST2 concentrations was present early and sustained through the duration of follow-up (log rank p=0.01). CONCLUSIONS: In patients undergoing HF therapy guided by invasive monitoring, sST2 concentrations were associated with impending failure to reduce filling pressures, and predicted impending events. Elevated sST2 values early in the ICU course theoretically could assist therapeutic decision-making in advanced stage HF patients. Trial registration: ClinicalTrials.gov Identifier: NCT00595738.
PMID: 22830581 [PubMed - as supplied by publisher]