Anker Markus S, Lück Laura C, Khan Muhammad Shahzeb, Porthun Jan, Hadzibegovic Sara, Lena Alessia, Wilkenshoff Ursula, Weinländer Pia, Evertz Ruben, Totzeck Matthias, Mahabadi Amir A, Rassaf Tienush, Anker Stefan D, Bullinger Lars, Keller Ulrich, Karakas Mahir, Landmesser Ulf, Butler Javed, von Haehling Stephan
Charité - University Medicine Berlin corporate member of Free University Berlin, and Humboldt-University Berlin, Berlin, Germany.
German Centre for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany.
Eur J Heart Fail. 2024 Nov 26. doi: 10.1002/ejhf.3497.
Traditional cardiovascular (CV) biomarkers (high-sensitivity troponinT [hsTnT] and N-terminal pro-B-type natriuretic peptide [NT-proBNP]) are important to monitor cancer patients' cardiac function and to assess prognosis. Newer CV biomarkers (mid-regional pro-adrenomedullin [MR-proADM], C-terminal pro-arginine vasopressin [copeptin], and mid-regional pro-atrial natriuretic peptide [MR-proANP]) might outperform traditional biomarkers.
Overall, 442 hospitalized cancer patients without significant CV disease or current infection were enrolled (61 ± 15 years, 52% male, advanced cancer stage: 85%) and concentrations of CV biomarkers were analysed. Differences in echocardiographic, clinical, laboratory parameters were assessed. Patients were followed for up to 69 months for all-cause mortality. In univariable analyses, MR-proADM, hsTnT, copeptin, MR-proANP, and NT-proBNP predicted all-cause mortality. In multivariable analyses (adjusted for sex, age, Eastern Cooperative Oncology Group performance status, estimated glomerular filtration rate [eGFR], C-reactive protein, anti-cancer therapy, reason for hospitalization, cancer stage and type), only MR-proADM remained an independent predictor of mortality (MR-proADM per 1 ln: hazard ratio [HR] 2.27, 95% confidence interval [CI] 1.47-3.50], p < 0.001). MR-proADM had the highest area under the curve (AUC) using receiver operating characteristic analysis (AUC [95% CI] 0.74 [0.69-0.79]; hsTnT: AUC 0.69; copeptin: AUC 0.66; MR-proANP: AUC 0.63; NT-proBNP: AUC 0.62). Optimal cut-point for mortality prediction with MR-proADM was 0.94 nmol/L (HR 2.43 [95% CI 1.92-3.06], p < 0.001). Patients with MR-proADM >0.94 nmol/L were older, more often had cancer stage IV, showed reduced performance status, eGFR, haemoglobin, diastolic left ventricular function, and elevated systolic pulmonary artery pressure.
MR-proADM is an independent predictor of mortality in advanced stage, hospitalized cancer patients without significant CV disease or current infection. The optimal MR-proADM cut-point for mortality prediction was 0.94 nmol/L with hazards for mortality being approximately 2.5 times higher. There was a continuous increase in mortality risk with stepwise increase of MR-proADM concentrations. Elevated concentrations of MR-proADM were also associated with reduced performance status and mildly reduced left ventricular diastolic function as well as higher age and more often cancer stage IV.
传统心血管（CV）生物标志物（高敏肌钙蛋白T [hsTnT] 和N末端B型利钠肽原 [NT-proBNP]）对于监测癌症患者的心功能和评估预后很重要。新型CV生物标志物（中段肾上腺髓质素原 [MR-proADM]、C末端精氨酸加压素原 [copeptin] 和中段心房利钠肽原 [MR-proANP]）可能比传统生物标志物表现更优。
总体而言，纳入了442例无明显CV疾病或当前感染的住院癌症患者（61±15岁，52%为男性，晚期癌症阶段：85%），并分析了CV生物标志物的浓度。评估了超声心动图、临床和实验室参数的差异。对患者进行长达69个月的全因死亡率随访。在单变量分析中，MR-proADM、hsTnT、copeptin、MR-proANP和NT-proBNP可预测全因死亡率。在多变量分析中（根据性别、年龄、东部肿瘤协作组体能状态、估计肾小球滤过率 [eGFR]、C反应蛋白、抗癌治疗、住院原因、癌症阶段和类型进行调整），只有MR-proADM仍然是死亡率的独立预测因子（MR-proADM每增加1 ln：风险比 [HR] 2.27，95%置信区间 [CI] 1.
