Physicians' Academy for Cardiovascular Education

BNP and troponin I measurements did not improve risk stratification of acute HF patients

Measurement of troponin and natriuretic peptides shortly after admission in patients with heart failure—does it add useful prognostic information? An analysis of the Value of Endothelin Receptor Inhibition with Tezosentan in Acute heart failure Studies (VERITAS)

Cleland JGF, Teerlink JR, Davison BA, et al, for the VERITAS Investigators - Eur J Heart Failure 2017; 19(6):739–747

Background

Patients with acute heart failure (AHF) are at high risk of HF re-hospitalization and death within 30 days of admission [1]. Accurate risk stratification at the acute phase could support physicians to select the most appropriate treatment strategies, which might lead to a better prognosis for these patients [2]. However, existing predictive models are of limited clinical use because they are not very accurate, especially for readmissions [3].

In this retrospective analysis of the Value of Endothelin Receptor Inhibition with Tezosentan in

Acute heart failure (VERITAS) studies [4], the value of adding BNP and troponin I to conventional prognostic markers was evaluated. For this purpose, multivariable prognostic models including baseline clinical data were created for:

a) the composite of death, in-hospital worsening HF, or HF re-hospitalization at 30 days,

b) death or HF re-hospitalization at 30 days,

c) death at 90 days.

Excluding biomarker data, the multivariable model included age, heart rate, respiratory rate, SBP, history of COPD, history of DM, history congestive HF, history of renal impairment, dyspnea severity by visual analogue scale (dyspnea VAS) at baseline, albumin, blood urea nitrogen (BUN), hemoglobin, and sodium.

The data of 1347 patients (93%) in the VERITAS studies were analyzed. They had been enrolled within 24 hours from admission for AHF, and were randomized to intravenous tezosentan, an endothelin antagonist, or placebo. BNP and troponins were measured retrospectively on stored plasma, because they had been measured in only 20% of patients when the study was ongoing. Moreover, troponin I, and not troponin T, was used for this analysis, because a higher number of troponin T values were missing, and troponin I and T values were highly correlated.

Note: the VERITAS program was discontinued prematurely because of the low probability of achieving a significant treatment effect.

Main results

Conclusion

For AHF patients in the VERITAS studies, the predictive value of conventional clinical assessments made shortly after admission was poor at identifying death or readmission at 30 days, but somewhat better at predicting all-cause mortality at 90 days. Measurement of BNP and troponin I at admission did not substantially improve the prediction of any of the specified outcomes.

References

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Find this article online at Eur J Heart Failure