Page 24 - Biomarkers for risk stratification and guidance in heart failure

Multimarker risk score in emergency department dyspnea
INTRODUCTION
Acute onset or progressive increase in dyspnea can indicate both harmless as well
as highly lethal conditions1, 2. Therefore, accurate risk assessment is important
in this patient group. Especially short-term risk stratification can help to triage 2 which patients require particular and immediate attention. Whereas risk scores
are widely used in other acute settings such as acute coronary syndrome3, 4
and acute pulmonary embolism5, a risk score for short-term risk assessment
in acute or recent onset dyspnea is not yet established. A risk score for long-
term mortality in acute dyspnea has been developed 6 that takes into account
N-terminal pro-B-type natriuretic peptide (NT-proBNP): one of the most studied
and clinically implemented biomarkers in acute dyspnea 7. However, many more
biomarkers have emerged over the last years and they are suggested to provide
additional or superior prognostic information in patients with dyspnea and acute
heart failure 8-13. Moreover, a single biomarker may not be sufficient to provide
adequate risk assessment14. Most studies thus far have looked into acute heart
failure alone rather than acute or recent-onset dyspnea10-12, 15 and studies that
have assessed the prognostic value of multiple biomarkers in acute dyspnea have
compared biomarkers rather than examining the impact of combining them8, 9.
We hypothesize that prediction of risk in patients with dyspnea at the emergency
department (ED) could be improved by combining multiple biomarkers1, 2. We
studied NT-proBNP, high-sensitivity cardiac troponinT (hs-cTnT), Cystatin-C
(Cys-C), high-sensitivity C-reactive protein (hs-CRP), and Galectin-3 (Gal-3) because
these are established biomarkers with different pathophysiological backgrounds
(i.e. myocyte stretch, myocardial damage, renal function, inflammation and
fibrosis, respectively) and investigated the value of a multimarker strategy for risk
assessment in dyspnea at the ED.
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