National University Heart Centre, Singapore.
Yong Loo Lin School of Medicine, National University, Singapore.
Clin Chem. 2021 Jan 8;67(1):216-226. doi: 10.1093/clinchem/hvaa287.
Consideration of circulating biomarkers for risk stratification in heart failure (HF) is recommended, but the influence of atrial fibrillation (AF) on prognostic performance of many markers is unclear. We investigated the influence of AF on the prognostic performance of circulating biomarkers in HF.
N-terminal pro-B-type natriuretic peptide (NT-proBNP), mid-regional-pro-atrial natriuretic peptide, C-type natriuretic peptide (CNP), NT-proCNP, high-sensitivity troponin-T, high-sensitivity troponin-I, mid-regional-propeptide adrenomedullin, co-peptin, growth differentiation factor-15, soluble Suppressor of Tumorigenicitiy (sST2), galectin-3, and procalcitonin plasma concentrations were measured in a prospective, multicenter study of adults with HF. AF was defined as a previous history of AF, and/or presence of AF/flutter on baseline 12-lead electrocardiogram. The primary outcome was the composite of HF-hospitalization or all-cause mortality at 2 years.
Among 1099 patients (age 62 ± 12years, 28% female), 261(24%) patients had AF. Above-median concentrations of all biomarkers were independently associated with increased risk of the primary outcome. Significant interactions with AF were detected for galectin-3 and sST2. In considering NT-proBNP for additive risk stratification, sST2 (adjusted hazard ratio [AHR]1.85, 95%confidence interval [C.I.] 1.17-2.91) and galectin-3 (AHR1.85, 95%C.I. 1.09-2.45) were independently associated with increased primary outcome only in the presence of AF. The prognostic performance of sST2 was also stronger in AF for all-cause mortality (AF: AHR2.82, 95%C.I. 1.26-6.21; non-AF: AHR1.78, 95% C.I. 1.14-2.76 without AF), while galectin-3 predicted HF-hospitalization only in AF (AHR1.64, 95%C.I. 1.03-2.62).
AF modified the prognostic utility of selected guideline-endorsed HF-biomarkers. Application of markers for prognostic purposes in HF requires consideration of the presence or absence of AF.
ACTRN12610000374066.
考虑将循环生物标志物用于心力衰竭（HF）的危险分层是合理的，但心房颤动（AF）对许多标志物预后性能的影响尚不清楚。我们研究了 AF 对 HF 中循环生物标志物预后性能的影响。
在一项前瞻性、多中心的 HF 成年患者研究中，测量了 N 末端 pro-B 型利钠肽（NT-proBNP）、中段 pro-atrial 利钠肽、C 型利钠肽（CNP）、NT-proCNP、高敏肌钙蛋白-T、高敏肌钙蛋白-I、中段 propeptide 肾上腺髓质素、共同肽、生长分化因子-15、可溶性肿瘤抑制因子（sST2）、半乳糖凝集素-3 和降钙素原的血浆浓度。AF 定义为既往有 AF 病史，和/或基线 12 导联心电图上存在 AF/扑动。主要结局是 2 年时 HF 住院或全因死亡率的复合终点。
在 1099 例患者（年龄 62±12 岁，28%为女性）中，261 例（24%）患者有 AF。所有生物标志物的中位数以上浓度均与主要结局风险增加独立相关。Galectin-3 和 sST2 与 AF 存在显著交互作用。在考虑 NT-proBNP 进行附加危险分层时，sST2（调整后的危险比 [AHR]1.85，95%置信区间 [CI] 1.17-2.91）和 galectin-3（AHR1.85，95%CI 1.09-2.45）仅在存在 AF 时与主要结局增加相关。sST2 对全因死亡率的预后性能在 AF 中也更强（AF：AHR2.82，95%CI 1.26-6.21；非 AF：AHR1.78，95%CI 1.14-2.76 无 AF），而 galectin-3 仅在 AF 中预测 HF 住院（AHR1.64，95%CI 1.03-2.62）。
AF 改变了选定指南推荐的 HF 生物标志物的预后应用价值。为预后目的应用标志物需要考虑 AF 的存在与否。
ACTRN12610000374066。
