Page 152 - Biomarkers for risk stratification and guidance in heart failure

Gal-3 is a reasonable prognostic marker for short- and long-term outcome in acute HF.20,22
Hs-cTnT, released from the heart due to myocyte injury, is associated with all cause mortality in acute23 and chronic24 heart failure, even in patients with normal conventional TnT levels. hs-CRP, a marker for inflammation, has demonstrated prognostic power in both acute25,26 and chronic27 heart failure, independent of clinical risk factors and other biomarkers among which (NT-pro)BNP. Cystatin C, a marker for renal function that strongly reflects glomerular filtration rate28 is a strong prognostic marker for mortality, in AHF independent of NT-proBNP29 and TnT30, even in patients with normal plasma creatinine29.
Thus, all markers that were analyzed in our multi marker study have proven
prognostic power in heart failure. Although all investigated biomarkers had
incremental value on top of the clinical risk model (table 3, chapter2), Gal-3 was
dropped from the final biomarker panel and NT-proBNP was excluded from the
final prediction model including other clinical parameters. This drop-out might
partially be explained by the existence of significant correlations between both
Gal-3 and NT-proBNP and other biomarkers31. The previously reported findings
about the inferior predictive value of NT-proBNP for short-term risk prediction
compared to other biomarkers in acute HF might also play an important role in
the exclusion of NT-proBNP in the final model. Moreover, as our study included
patients with dyspnea and more then 40% of patients had other diagnoses than
acute HF, knowledge of prognostic power of these biomarkers in other dyspnea
causing diseases is important. Although Gal-3 has recently been related to
long term cardiovascular mortality in coronary artery disease32 and levels are
increased in acute coronary syndrome (ACS) patients compared to patients with 7 stable coronary artery disease33, prognostic effect of Gal-3 in ACS patients still
remains to be assessed. Gal-3 is also known to be elevated in atrial fibrillation and pneumonia, in contrast to COPD, however no data exists on prognostic effect of Gal-3 in pneumonia, COPD or pulmonary embolism. In contrast, CRP, 34-36 troponin37-40 and cystatin C41-43 have been correlated to prognosis or disease severity in a wide variety of diseases causing dyspnea.
General Discussion
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