Incremental prognostic values of serum tenascin-C levels with blood B-type natriuretic peptide testing at discharge in patients with dilated cardiomyopathy and decompensated heart failure.

BACKGROUND

This study investigates the predictive value of serum tenascin-C (TN-C), which is observed at the active sites of ongoing tissue remodeling, for cardiac events of patients with dilated cardiomyopathy (DCM).

METHODS AND RESULTS

In this trial, 110 consecutive patients hospitalized with heart failure (HF) resulting from DCM underwent assessments of serum TN-C and plasma brain natriuretic peptide (BNP) levels at discharge and were followed up for 22.4 months. Cardiac function and hemodynamics were assessed invasively in 60 of these patients at discharge. There were 19 cardiac events (14 rehospitalizations, 3 deaths from refractory HF, and 2 sudden deaths) during follow-up. The average levels of TN-C and BNP were 73 +/- 38 ng/mL and 279 +/- 414 pg/mL, respectively. The optimal cutoff value for serum TN-C levels predicted cardiac events were >or=78.4 ng/mL, whereas BNP levels were >or=219 pg/mL. Patients with levels higher than this had significantly higher cardiac events and serum TN-C >or=78.4 ng/mL had an incremental predictive power with BNP for cardiac events. Left ventricular end-diastolic volume was significantly larger, and mean pulmonary arterial pressure was elevated in patients with serum TN-C >or=78.4 ng/mL.

CONCLUSIONS

The combined index of serum levels for TN-C and BNP at discharge predicts cardiac events from decompensated HF. Additionally, elevated serum TN-C levels reflect left ventricular and pulmonary vascular remodeling in DCM patients.