Evaluation of novel biomarkers for the diagnosis of acute destabilised heart failure in patients with shortness of breath
- 1Department of Laboratory Medicine, Konventhospital Barmherzige Brueder Linz, Linz, Austria
- 2Department of Internal Medicine, Krankenhaus Bad Ischl, Austria
- Correspondence to Dr Thomas Mueller, Department of Laboratory Medicine, Konventhospital Barmherzige Brueder, Seilerstaette 2-4, A-4020 Linz, Austria;
- Accepted 26 May 2009
- Published Online First 11 June 2009
Objective: The evaluation of novel biomarkers for the diagnosis of acute destabilised heart failure (HF).
Design: Prospectively conducted study on diagnostic accuracy.
Setting: Emergency department of a tertiary care hospital.
Patients: 251 consecutive patients presenting to the emergency department with dyspnoea as the chief complaint.
Main outcome measures: Index tests were plasma concentrations of 10 biomarkers (BNP, MR-proANP, MR-proADM, copeptin, CT-proET-1, ST2, adiponectin, chromogranin A, proguanylin and prouroguanylin). The reference standard was the diagnosis of acute destabilised HF, which was based on the Framingham score for HF plus echocardiographic evidence of systolic or diastolic dysfunction.
Results: Median plasma concentrations of all 10 biomarkers were higher in patients with dyspnoea attributable to acute destabilised HF (n = 137) than in patients with dyspnoea attributable to other reasons (n = 114). Applying receiver operating characteristic curve (ROC) analyses, areas under the curve (AUCs) for BNP (0.92) and MR-proANP (0.88) were significantly higher than the AUCs of the other eight biomarkers (MR-proADM, 0.75; adiponectin, 0.73; CT-proET-1, 0.72; proguanylin, 0.68; ST2, 0.67; prouroguanylin, 0.62; copeptin, 0.62; and chromogranin A, 0.56). In multivariate logistic regression analysis only increased BNP and MR-proANP concentrations remained independent markers for the diagnosis of HF. Both markers alone or in combination added similar diagnostic information besides all clinical information available in the emergency department.
Conclusions: The data showed that BNP and MR-proANP were the only independent diagnostic markers of HF. Both markers provided similar diagnostic information and were clinically useful as an aid in the diagnosis of acute destabilised HF in an emergency setting.
Funding We thank Abbott Diagnostics, BRAHMS AG, Critical Diagnostics and BioVendor Laboratory Medicine Inc for providing reagents free of charge.
Competing interests TM has received speaking fees from Abbott Diagnostics, and BRAHMS AG.
Provenance and peer review Not commissioned; externally peer reviewed.